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Jiang X, Guo H, Xiao W, Wang L, Wu D, Liu J, Zhao Q, Shao Y. Advancements in Non-Invasive Intracranial Pressure Monitoring via Optic Nerve Sheath Diameter Measurement. Med Sci Monit 2025; 31:e947237. [PMID: 40413578 PMCID: PMC12121452 DOI: 10.12659/msm.947237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Accepted: 03/15/2025] [Indexed: 05/27/2025] Open
Abstract
Intracranial pressure (ICP) monitoring is the mainstay of treatment for patients with brain tumors, hydrocephalus, cerebral edema, and traumatic brain injury (TBI). At present, there are 2 main monitoring methods: non-invasive and invasive. Although invasive monitoring of ICP is the criterion standard, non-invasive approaches based on measurement of optic nerve sheath diameter (ONSD) are becoming increasingly popular because of their simplicity, low cost, and accuracy. Ultrasound (US) measurement of ONSD is especially useful because it allows dynamic evaluation of ICP over the hospital and treatment period in a real-time manner and can be performed bedside for better patient acceptance. This paper reviews the research progress, and highlights the advantages, performance, and results of various ONSD measurement approaches, including US-based ONSD measurement, with regard to its principles, operation method, and clinical applications, as well as ONSD measurement by other techniques such as computed tomography (CT) and magnetic resonance imaging (MRI). New developments, including use of the ONSD/ocular transverse diameter (ETD) index and possible future studies on ONSD-based/assisted therapy and treatment for patients with TBI, stroke, and other conditions that can increase ICP will also be discussed.
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Küçük AO, Hatınoğlu N, Apaydin U, Altunalan T, Küçük MP. The association of early passive mobilization with intracranial pressure in the adult intensive care unit: A prospective, cohort study. Nurs Crit Care 2025; 30:e13197. [PMID: 39449552 PMCID: PMC12093286 DOI: 10.1111/nicc.13197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 09/26/2024] [Accepted: 10/11/2024] [Indexed: 10/26/2024]
Abstract
BACKGROUND Early mobilization are key components of the ABCDEF Care Bundle and critical treatments to reduce acquired muscle weakness, delirium and prolonged intensive care unit (ICU) stay. AIM This study aimed to determine whether routine early mobilization related to intracranial pressure in intensive care patients on mechanical ventilation, using optic nerve sheath diameter measurement (ONSD). STUDY DESIGN This study was planned as a prospective, cohort study in the third-step adult ICU of a faculty hospital. The study included only patients who were intubated and followed up on a mechanical ventilator and were clinically stable. Passive range of motion (PROM) exercises were performed daily by the physiotherapists as part of routine care from the day of hospitalization. ONSD was assessed before, during and 10 min after PROM exercises. RESULTS The study included 20 eligible patients out of the 142 who were evaluated upon admission to the ICU. The median age of the patients was 65 years, and nine (45%) of them were female. The analyses showed that there was no statistically significant change in ONSD during and at the end of the PROM (ONSD right eye p:.621, Partial η2: 0.025, ONSD left eye p:.935, Partial η2: 0.004). Similarly, there was no statistically significant change in haemodynamic parameters in during and at the end of the PROM (Heart beat p:.849, Partial η2: 0.009, Systolic Pressure p:.435, Partial η2: 0.043, Diastolic Pressure p:.128, Partial η2:0.103, Saturation p:.103, Partial η2: 0.113 and Respiratory rate p:.071, Partial η2:0.130). CONCLUSION This study suggests that daily extremity physiotherapy exercises can be safely applied without causing increased intracranial pressure or haemodynamic instability in intensive care patients followed up on mechanical ventilation, including patients with vasopressor therapy. RELEVANCE TO CLINICAL PRACTICE Early mobilization, including PROM, is considered safe in terms of intracranial pressure for intubated patients in the ICU.
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Affiliation(s)
- Ahmet Oğuzhan Küçük
- Department of Pulmonary DiseasesDivision of Intensive Care Medicine, School of Medicine, Karadeniz Technical UniversityTrabzonTürkiye
- Department of Computer ScienceFaculty of Science, Karadeniz Technical UniversityTrabzonTürkiye
| | - Neslihan Hatınoğlu
- Department of Anesthesiology and ReanimationDivision of Intensive Care Medicine, School of Medicine, Karadeniz Technical UniversityTrabzonTürkiye
| | - Umut Apaydin
- Department of Physical Therapy and Rehabilitation, Health Science FacultyKaradeniz Technical UniversityTrabzonTürkiye
| | - Turgay Altunalan
- Department of Physical Therapy and Rehabilitation, Health Science FacultyKaradeniz Technical UniversityTrabzonTürkiye
| | - Mehtap Pehlivanlar Küçük
- Department of Pulmonary DiseasesDivision of Intensive Care Medicine, School of Medicine, Karadeniz Technical UniversityTrabzonTürkiye
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ElBheery MAY, Mousa AM, Eltayab MA, Enayet A. Estimation of Intracranial Pressure in Patients with Traumatic Brain Injury by Optic Nerve Sheath Diameter Ultrasonography. Oper Neurosurg (Hagerstown) 2025:01787389-990000000-01512. [PMID: 40116493 DOI: 10.1227/ons.0000000000001549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2024] [Accepted: 11/26/2024] [Indexed: 03/23/2025] Open
Abstract
BACKGROUND AND OBJECTIVES Intracranial pressure (ICP) is the cornerstone for physiological neuromonitoring after traumatic brain injuries (TBIs). Optic nerve sheath diameter (ONSD) ultrasonography serves as a noninvasive alternative for the gold standard invasive ICP monitoring devices. We aimed to evaluate the use of ultrasound ONSD as a tool for early detection and follow-up of increasing ICP in TBI in a low socioeconomic developing country where invasive devices are not always available. METHODS A prospective observational study was conducted on 50 polytrauma patients with TBI, who were older than 18 years with and Glasgow Coma Scale above 5, and a computed tomography (CT) brain in trauma survey showing signs of increasing ICP. All patients were recruited from the emergency department and intensive care unit at Cairo and October 6 University hospitals from January to May 2022. Clinical assessment, CT brain, and ONSD ultrasonography were performed on admission, after 12 hours, and after 48 hours. ONSD 5.0 mm was correlated with raised ICP in this study. RESULTS ONSD ranged from 4.6 to 7.1 mm with mean ± SD of 5.93 ± 0.55 on admission. On the second follow-up, the range regressed to 4.5 to 6.0 mm with mean ± SD of 4.8 ± 0.48, suggesting a decrease in the measurements of ONSD after receiving treatment either medical or surgical. The correlation between the measurement of ONSD and the CT findings indicating raised or decreased ICP was found in 94%, 82%, and 90% of patients on admission, first follow-up, and second follow-up, respectively. The specificity of ONSD measurement was 100% on admission and second follow-up, and its accuracy was 94% and 90 % for both occasions, respectively. CONCLUSION Bedside ONSD measurements are highly correlated with CT brain findings and dynamic changes in ICP in response to head trauma management protocols. Hence, ultrasonic ONSD can replace invasive monitoring in following the ICP of patients with TBI.
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Affiliation(s)
| | | | - Mohamed Amr Eltayab
- Neurosurgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
| | - AbdElRhman Enayet
- Neurosurgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt
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Edlow JA. Misdiagnosis of Acute Headache: Mitigating Medico-legal Risks. Emerg Med Clin North Am 2025; 43:67-80. [PMID: 39515944 DOI: 10.1016/j.emc.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
Headache is a common complaint of patients in the emergency department. The large majority of them have self-limited causes but some have life, limb, brain, or vision-threatening secondary causes. The job of the emergency physicians is to distinguish the 2 groups. This article focuses on clinical tips to avoid or at least mitigate medico-legal risk in patients with headache. Each process of care-history, physical examination, laboratory testing, brain imaging, spinal fluid analysis, specialist consultation, and documentation-will be considered.
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Affiliation(s)
- Jonathan A Edlow
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA; Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Becker AE, Dixon KL, Kirschen MP, Conlon TW, Glau CL. Advances in Point-of-Care Ultrasound in Pediatric Acute Care Medicine. Indian J Pediatr 2025; 92:170-177. [PMID: 38842749 DOI: 10.1007/s12098-024-05180-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
Pediatric point-of-care ultrasonography (POCUS) has grown in utilization and is now an integral part of pediatric acute care. Applications within the pediatric critical care, neonatology and pediatric emergency were once limited to evaluation of undifferentiated shock states, abdominal free fluid assessments in trauma resuscitation and procedural guidance. The body of pediatric POCUS literature is ever expanding and recently published international consensus guidelines are available to guide implementation into clinical practice. The authors present a review of emerging applications and controversies within thoracic, hemodynamic, neurologic, and ocular POCUS in pediatric acute care medicine.
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Affiliation(s)
| | | | - Matthew P Kirschen
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thomas W Conlon
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Anesthesiology and Critical Care Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Christie L Glau
- Children's Hospital of Philadelphia, Philadelphia, PA, USA.
- Department of Anesthesiology and Critical Care Medicine, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
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Hoyne J, Edlow J. Airway Management in Patients With Acute Brain Injury or Ischemia. J Emerg Med 2025:S0736-4679(24)00407-4. [PMID: 40348691 DOI: 10.1016/j.jemermed.2024.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2024] [Revised: 12/02/2024] [Accepted: 12/22/2024] [Indexed: 05/14/2025]
Abstract
BACKGROUND Airway management and endotracheal intubation are essential skills of emergency medicine. Patients with acute brain injury or ischemia have complex physiology, and without caution, endotracheal intubation can inadvertently lead to secondary brain injury. This article summarizes the evidence behind airway management for patients with acute brain injury or ischemia. OBJECTIVES We present data that will help to clarify our recommended actions before, during, and after endotracheal intubation for a patient with acute brain injury or ischemia. DISCUSSION The principles described in this article are centered around avoiding secondary brain injury. Before intubation, it is important to avoid extremes of blood pressure, ensure the patient is preoxygenated, and manage elevated intracranial pressure. We recommend performing a full neurological examination, if feasible. During intubation, using a hemodynamically neutral induction agent such as ketamine or etomidate minimizes the risk of hypotension, which can worsen ischemia. Ketamine was traditionally avoided but has been shown to not affect the cerebral perfusion pressure, and thus is acceptable to use in this patient population. We also recommend the use of video laryngoscopy. Following intubation, we recommend adjusting ventilator settings to target eucapnia. Adequate sedation can assist with the management of intracranial pressure. The use of electroencephalogram (EEG) monitoring can identify non-convulsive status epilepticus. CONCLUSION This evidence-based review of airway management in patients with acute brain injury or ischemia can minimize the risk of secondary brain injury and optimize patient outcomes.
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Affiliation(s)
- Jake Hoyne
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts.
| | - Jonathan Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
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Gonzalez JM, Ortega J, Snowden K, Larrieu-Jimenez P, Crenshaw N, Nadeau C, McGhee S. Point of Care Ultrasonography for the Evaluation of Ocular Emergencies. Adv Emerg Nurs J 2025; 47:37-48. [PMID: 39641540 DOI: 10.1097/tme.0000000000000549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2024]
Abstract
Ocular point-of-care ultrasound (POCUS) has emerged as a pivotal tool in evaluating ocular emergencies in the emergency department (ED), addressing millions of annual visits for eye complaints in the United States. Compared to traditional imaging methods, ocular POCUS's advantages include efficiency, repeatability, and safety. Adequate patient preparation, positioning, and transducer selection are essential for obtaining high-quality images. Ocular POCUS offers static and dynamic imaging,aiding in diagnosing conditions like retinal detachment and increased intracranial pressure. Emergency nurse practitioners (ENPs) can use ocular POCUS to expedite diagnosis and interventions, improving patient outcomes. Overall, ocular POCUS represents a rapid, non-invasive, and effective means of evaluating ocular emergencies in the ED, promising improved diagnostic accuracy, treatment initiation, and, ultimately, enhanced patient care.
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Affiliation(s)
- Juan Manuel Gonzalez
- Author Affiliations: University of Miami School of Nursing and Health Studies, Coral Gables, Florida (Drs Gonzalez, Ortega, Snowden, Larrieu-Jimenez, and Crenshaw); University of South Florida, College of Nursing, Tampa, Florida (Dr Nadeau); and The Ohio State University, College of Nursing, Columbus, Ohio (Dr McGhee)
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Kus C, Acehan S, Satar S, Gulen M, Sevdimbas S, Akdoganlar Aİ, Gorur M. Optic nerve sheath diameters predict mortality and severity in hepatic encephalopathy. Eur J Gastroenterol Hepatol 2024; 36:1426-1436. [PMID: 39373626 DOI: 10.1097/meg.0000000000002858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2024]
Abstract
OBJECTIVE The aim of this study was to compare the predictive power of optic nerve sheath diameter (ONSD) measured by brain computed tomography (CT) in patients diagnosed with hepatic encephalopathy (HE) in the emergency department, with other factors for mortality and disease severity. MATERIALS AND METHODS A total of 217 patients aged 18 years and older with acute decompensation of cirrhosis diagnosed with HE in the emergency department were included in the study. To compare with patients diagnosed with HE, a total of 217 individuals were included in the study as the healthy control group. ONSD measurements were performed on both the HE patients and the healthy control group in the brain CT. RESULTS The mortality rate of HE patients was 32.7%. Regarding the severity of the disease, 53% of the patients had late-stage HE. The presence of acute-on-chronic liver failure was detected in 51.4% of patients. The mortality rate among acute-on-chronic liver failure patients was 56.6%. According to the study data, ONSD, creatinine, lactate, and procalcitonin were independent predictors of mortality. Meanwhile, Child-Pugh score, direct bilirubin, ONSD, ammonia, and total bilirubin were independent predictors of disease severity. In the receiver operating characteristic curve analysis, the ONSD had the highest predictive power for mortality and disease severity among the determined predictive values. CONCLUSION The data from the study suggests that assessing the ONSD through brain CT scans in individuals diagnosed with HE in the emergency department may provide valuable insights for clinicians, aiding in the prediction of both mortality rates and the severity of the disease.
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Affiliation(s)
- Cumali Kus
- Emergency Medicine Clinic, Adana City Training and Research Hospital, Health Sciences University, Adana, Turkey
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Bastani Viarsagh S, Agar A, Lawlor M, Fraser C, Golzan M. Non-invasive assessment of intracranial pressure through the eyes: current developments, limitations, and future directions. Front Neurol 2024; 15:1442821. [PMID: 39524910 PMCID: PMC11545690 DOI: 10.3389/fneur.2024.1442821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Accepted: 09/27/2024] [Indexed: 11/16/2024] Open
Abstract
Detecting and monitoring elevated intracranial pressure (ICP) is crucial in managing various neurologic and neuro-ophthalmic conditions, where early detection is essential to prevent complications such as seizures and stroke. Although traditional methods such as lumbar puncture, intraparenchymal and intraventricular cannulation, and external ventricular drainage are effective, they are invasive and carry risks of infection and brain hemorrhage. This has prompted the development of non-invasive techniques. Given that direct, non-invasive access to the brain is limited, a significant portion of research has focused on utilizing the eyes, which uniquely provide direct access to their internal structure and offer a cost-effective tool for non-invasive ICP assessment. This review explores the existing non-invasive ocular techniques for assessing chronically elevated ICP. Additionally, to provide a comprehensive perspective on the current landscape, invasive techniques are also examined. The discussion extends to the limitations inherent to each technique and the prospective pathways for future advancements in the field.
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Affiliation(s)
| | - Ashish Agar
- Ophthalmology Department, Prince of Wales Hospital, UNSW, Darlington, NSW, Australia
| | - Mitchell Lawlor
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Clare Fraser
- Save Sight Institute, University of Sydney, Sydney, NSW, Australia
| | - Mojtaba Golzan
- Vision Science Group (Orthoptics), Faculty of Health, UTS, Sydney, NSW, Australia
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Pandit AS, China M, Jain R, Jalal AHB, Jelen M, Joshi SB, Skye C, Abdi Z, Aldabbagh Y, Alradhawi M, Banks PDW, Stasiak MK, Tan EBC, Yildirim FC, Ruffle JK, D'Antona L, Asif H, Thorne L, Watkins LD, Nachev P, Toma AK. The utility of MRI radiological biomarkers in determining intracranial pressure. Sci Rep 2024; 14:23238. [PMID: 39369053 PMCID: PMC11455934 DOI: 10.1038/s41598-024-73750-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 09/20/2024] [Indexed: 10/07/2024] Open
Abstract
Intracranial pressure (ICP) is a physiological parameter that conventionally requires invasive monitoring for accurate measurement. Utilising multivariate predictive models, we sought to evaluate the utility of non-invasive, widely accessible MRI biomarkers in predicting ICP and their reversibility following cerebrospinal fluid (CSF) diversion. The retrospective study included 325 adult patients with suspected CSF dynamic disorders who underwent brain MRI scans within three months of elective 24-h ICP monitoring. Five MRI biomarkers were assessed: Yuh sella grade, optic nerve vertical tortuosity (VT), optic nerve sheath distension, posterior globe flattening and optic disc protrusion (ODP). The association between individual biomarkers and 24-h ICP was examined and reversibility of each following CSF diversion was assessed. Multivariate models incorporating these radiological biomarkers were utilised to predict 24-h median intracranial pressure. All five biomarkers were significantly associated with median 24-h ICP (p < 0.0001). Using a pair-wise approach, the presence of each abnormal biomarker was significantly associated with higher median 24-h ICP (p < 0.0001). On multivariate analysis, ICP was significantly and positively associated with Yuh sella grade (p < 0.0001), VT (p < 0.0001) and ODP (p = 0.003), after accounting for age and suspected diagnosis. The Bayesian multiple linear regression model predicted 24-h median ICP with a mean absolute error of 2.71 mmHg. Following CSF diversion, we found pituitary sella grade to show significant pairwise reversibility (p < 0.001). ICP was predicted with clinically useful precision utilising a compact Bayesian model, offering an easily interpretable tool using non-invasive MRI data. Brain MRI biomarkers are anticipated to play a more significant role in the screening, triaging, and referral of patients with suspected CSF dynamic disorders.
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Affiliation(s)
- Anand S Pandit
- High-Dimensional Neurology Group, UCL Queen Square Institute of Neurology, University College London, London, UK.
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK.
| | - Musa China
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- Division of Medicine, University College London, UCL, London, UK
| | - Raunak Jain
- Division of Medicine, University College London, UCL, London, UK
| | - Arif H B Jalal
- Division of Medicine, University College London, UCL, London, UK
| | - Maria Jelen
- Department of Psychology and Language Sciences, University College London, London, UK
| | - Shivani B Joshi
- Division of Medicine, University College London, UCL, London, UK
| | - Crystallynn Skye
- Division of Medicine, University College London, UCL, London, UK
| | - Zakee Abdi
- School of Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Yousif Aldabbagh
- Division of Medicine, University College London, UCL, London, UK
| | | | - Ptolemy D W Banks
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Martyna K Stasiak
- Department of Psychology and Language Sciences, University College London, London, UK
| | - Emily B C Tan
- Division of Medicine, University College London, UCL, London, UK
| | - Fleur C Yildirim
- Department of Psychology and Language Sciences, University College London, London, UK
| | - James K Ruffle
- High-Dimensional Neurology Group, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Linda D'Antona
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Hasan Asif
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Lewis Thorne
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Laurence D Watkins
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Parashkev Nachev
- High-Dimensional Neurology Group, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Ahmed K Toma
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
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Hirzallah MI, Lochner P, Hafeez MU, Lee AG, Krogias C, Dongarwar D, Hartman ND, Ertl M, Robba C, Malojcic B, Valaikiene J, Sarwal A, Hakimi R, Schlachetzki F. Optic Nerve Sheath Diameter Point-of-Care Ultrasonography Quality Criteria Checklist: An International Consensus Statement on Optic Nerve Sheath Diameter Imaging and Measurement. Crit Care Med 2024; 52:1543-1556. [PMID: 38836697 DOI: 10.1097/ccm.0000000000006345] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
OBJECTIVES To standardize optic nerve sheath diameter (ONSD) point-of-care ultrasonography (POCUS) and improve its research and clinical utility by developing the ONSD POCUS Quality Criteria Checklist (ONSD POCUS QCC). DESIGN Three rounds of modified Delphi consensus process and three rounds of asynchronous discussions. SETTING Online surveys and anonymous asynchronous discussion. SUBJECTS Expert panelists were identified according to their expertise in ONSD research, publication records, education, and clinical use. A total of 52 panelists participated in the Delphi process. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Three Delphi rounds and three asynchronous discussion rounds generated consensus on quality criteria (QC). This started with 29 QC in addition to other QC proposed by expert panelists. The QC items were categorized into probe selection, safety, body position, imaging, measurement, and research considerations. At the conclusion of the study, 28 QC reached consensus to include in the final ONSD POCUS QCC. These QC were then reorganized, edited, and consolidated into 23 QC that were reviewed and approved by the panelists. CONCLUSIONS ONSD POCUS QCC standardizes ONSD ultrasound imaging and measurement based on international consensus. This can establish ONSD ultrasound in clinical research and improve its utility in clinical practice.
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Affiliation(s)
- Mohammad I Hirzallah
- Department of Neurology, Section of Neurocritical Care and Vascular Neurology, Baylor College of Medicine, Houston, TX
- Center for Space Medicine, Baylor College of Medicine, Houston, TX
| | | | - Muhammad Ubaid Hafeez
- Department of Neurology, University of Texas Medical Branch at Galveston, Galveston, TX
| | - Andrew G Lee
- Department of Ophthalmology, Houston Methodist hospital, Houston, TX
- Department of Ophthalmology, Weill Cornell Medical College, New York, NY
| | - Christos Krogias
- Department of Neurology, Evangelisches Krankenhaus Herne, Academic Teaching Hospital of the Ruhr University Bochum, Herne, Germany
| | | | - Nicholas D Hartman
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael Ertl
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Chiara Robba
- Department of Anesthesia and Intensive Care, IRCCS Policlinico San Martino, Genova, Italy
- Dipartimento di Scienze Chirurgiche Diagnostiche Integrate, University of Genoa, Italy
| | - Branko Malojcic
- Department of Neurology, University Hospital Center Zagreb, Zagreb School of Medicine, Zagreb, Croatia
| | - Jurgita Valaikiene
- Clinic of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Aarti Sarwal
- Department of Neurology, Atrium Health Wake Forest Baptist, Winston-Salem, NC
| | - Ryan Hakimi
- Department of Medicine (Neurology Division), University of South Carolina School of Medicine-Greenville, Greenville, SC
- American Society of Neuroimaging, Kimberly, WI
| | - Felix Schlachetzki
- Department of Neurology, University of Regensburg, Center for Vascular Neurology and Intensive Care, Regensburg, Germany
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Bhide M, Juneja D, Singh O, Mohanty S. Optic nerve sheath diameters in nontraumatic brain injury: A scoping review and role in the intensive care unit. World J Crit Care Med 2024; 13:97205. [PMID: 39253313 PMCID: PMC11372515 DOI: 10.5492/wjccm.v13.i3.97205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/16/2024] [Accepted: 08/06/2024] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND Neuromonitoring in medical intensive care units is challenging as most patients are unfit for invasive intracranial pressure (ICP) modalities or unstable to transport for imaging. Ultrasonography-based optic nerve sheath diameter (ONSD) is an attractive option as it is reliable, repeatable and easily performed at the bedside. It has been sufficiently validated in traumatic brain injury (TBI) to be incorporated into the guidelines. However, currently the data for non-TBI patients is inconsistent for a scientific recommendation to be made. AIM To compile the existing evidence for understanding the scope of ONSD in measuring ICP in adult non-traumatic neuro-critical patients. METHODS PubMed, Google Scholar and research citation analysis databases were searched for studies in adult patients with non-traumatic causes of raised ICP. Studies from 2010 to 2024 in English languages were included. RESULTS We found 37 articles relevant to our search. The cutoff for ONSD in predicting ICP varied from 4.1 to 6.3 mm. Most of the articles used cerebrospinal fluid opening pressure followed by raised ICP on computed tomography/magnetic resonance imaging as the comparator parameter. ONSD was also found to be a reliable outcome measure in cases of acute ischaemic stroke, intracerebral bleeding and intracranial infection. However, ONSD is of doubtful utility in septic metabolic encephalopathy, dysnatremias and aneurysmal subarachnoid haemorrhage. CONCLUSION ONSD is a useful tool for the diagnosis of raised ICP in non-traumatic neuro-critically ill patients and may also have a role in the prognostication of a subset of patients.
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Affiliation(s)
- Madhura Bhide
- Institute of Critical Care Medicine, Kalinga Institute of Medical Sciences, Bhubaneshwar 751024, Odisha, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Omender Singh
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Shakya Mohanty
- Institute of Critical Care Medicine, Kalinga Institute of Medical Sciences, Bhubaneshwar 751024, Odisha, India
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Hansen HC, Sperhake JP, Matschke J, Ondruschka B, Helmke K. Experimental Analysis of Echogenic Signals Appearing in Optic Nerve Ultrasound. Neurocrit Care 2024:10.1007/s12028-024-02057-4. [PMID: 39085502 DOI: 10.1007/s12028-024-02057-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/21/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Hans-Christian Hansen
- University Hamburg and Neurological Department, Friedrich-Ebert-Krankenhaus Neumuenster, Friesenstrasse 11, 24534, Neumünster, Germany.
| | - Jan-Peter Sperhake
- Institute of Legal Medicine, University Medical Center of Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany
| | - Jakob Matschke
- Institute of Neuropathology, University Medical Center of Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center of Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Germany
| | - Knut Helmke
- Department Pediatric Radiology, University Medical Center of Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Guloglu H, Cetinkaya D, Oge T, Bilir A. Evaluation of the effect of trendelenburg position duration on intracranial pressure in laparoscopic hysterectomies using ultrasonographic optic nerve sheath diameter measurements. BMC Anesthesiol 2024; 24:238. [PMID: 39010013 PMCID: PMC11247807 DOI: 10.1186/s12871-024-02624-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 07/08/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND During laparoscopic surgery, pneumoperitoneum and Trendelenburg positioning applied to provide better surgical vision can cause many physiological changes as well as an increase in intracranial pressure. However, it has been reported that cerebral autoregulation prevents cerebral edema by regulating this pressure increase. This study aimed to investigate whether the duration of the Trendelenburg position had an effect on the increase in intracranial pressure using ultrasonographic optic nerve sheath diameter (ONSD) measurements. METHODS The near infrared spectrometry monitoring of patients undergoing laparoscopic hysterectomy was performed while awake (T0); at the fifth minute after intubation (T1); at the 30th minute (T2), 60th minute (T3), 75th minute (T4), and 90th minute (T5) after placement in the Trendelenburg position; and at the fifth minute after placement in the neutral position (T6). RESULTS The study included 25 patients. The measured ONSD values were as follows: T0 right/left, 4.18±0.32/4.18±0.33; T1, 4.75±0.26/4.75±0.25; T2, 5.08±0.19/5.08±0.19; T3, 5.26±0.15/5.26±0.15; T4, 5.36±0.11/5.37±0.12; T5, 5.45±0.09/5.48±0.11; and T6, 4.9±0.24/4.89±0.22 ( p < 0.05 compared with T0). ). No statistical difference was detected in all measurements in terms of MAP, HR and ETCO2 values compared to the T0 value (p > 0.05). CONCLUSIONS It was determined that as the Trendelenburg position duration increased, the ONSD values increased. This suggests that as the duration of Trendelenburg positioning and pneumoperitoneum increases, the sustainability of the mechanisms that balance the increase in intracranial pressure becomes insufficient. TRIAL REGISTRATION This study was registered at Clinical Trials.gov on 21/09/2023 (registration number NCT06048900).
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Affiliation(s)
- Hulya Guloglu
- Department of Anesthesiology and Reanimation, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Türkiye
| | - Dilek Cetinkaya
- Department of Anesthesiology and Reanimation, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Türkiye.
| | - Tufan Oge
- Department of Obstetrics and Gynecology, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Türkiye
| | - Ayten Bilir
- Department of Anesthesiology and Reanimation, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Türkiye
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15
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Breedt DS, Harrington B, Walker IS, Gretchel A, Vlok AJ. Optic nerve sheath diameter and eyeball transverse diameter in severe head injury and its correlation with intracranial pressure. Clin Neurol Neurosurg 2024; 242:108310. [PMID: 38788542 DOI: 10.1016/j.clineuro.2024.108310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Gold standard for determining intracranial pressure (ICP), intraventricular catheter, is invasive with associated risks. Non-invasive investigations like magnetic resonance imaging and ultrasonography have demonstrated correlation between optic nerve sheath diameter (ONSD) and raised ICP. However, computed tomography (CT) is accessible and less operator-dependent. Literature shows variable results regarding correlations between ICP and ONSD on CT. The study aimed to investigate correlations between raised ICP and ONSD, eyeball transverse diameter (ETD), and ONSD/ETD ratios on CT scan(s) of severe head injuries. METHODS A retrospective review of a three-year prospectively-maintained database of severe traumatic head injuries in patients who had ICP measurements and CT scans was conducted. Glasgow Coma Score (GCS), ICP, ONSD 3 mm and 9 mm behind the globe, ETD, ONSD/ETD ratios, CT Marshall Grade, and Glasgow Outcome Score (GOS) were recorded. Statistical analysis assessed correlations between ICP and CT measurements. RESULTS Seventy-four patients were assessed; mortality rate: 36.5 %. Assault (48.6 %) and pedestrian-vehicle collisions (21.6 %) were the most common mechanisms. CT Marshall Grade correlated significantly with 3 mm and 9 mm ONSD, ONSD/ETD ratios, GCS, and GCS motor score, which correlated significantly with GOS. No significant correlation was found between ICP and ONSD, ETD or ONSD/ETD ratios. Marshall Grade was not significantly associated with ICP measurements but correlated with injury severity. CONCLUSIONS Unlike previous studies, our study not only investigated the correlation between ICP and single variables (ONSD and ETD) but also the ONSD/ETD ratios. No correlations were observed between raised ICP and ONSD, ETD or ONSD/ETD ratio on CT in neurotrauma patients.
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Affiliation(s)
- Danyca Shadé Breedt
- Division of Neurosurgery, Department of Surgical Sciences, Faculty of Medicine and Health Science, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, PO Box 241, Cape Town 8000, South Africa.
| | - Brad Harrington
- Division of Neurosurgery, Department of Surgical Sciences, Faculty of Medicine and Health Science, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, PO Box 241, Cape Town 8000, South Africa
| | - Ian Scott Walker
- Division of Neurosurgery, Department of Surgical Sciences, Faculty of Medicine and Health Science, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, PO Box 241, Cape Town 8000, South Africa
| | - Armin Gretchel
- Division of Neurosurgery, Department of Surgical Sciences, Faculty of Medicine and Health Science, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, PO Box 241, Cape Town 8000, South Africa
| | - Adriaan Johannes Vlok
- Division of Neurosurgery, Department of Surgical Sciences, Faculty of Medicine and Health Science, Stellenbosch University, Francie van Zijl Drive, Tygerberg, 7505, PO Box 241, Cape Town 8000, South Africa
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Ong CJ, Chatzidakis S, Ong JJ, Feske S. Updates in Management of Large Hemispheric Infarct. Semin Neurol 2024; 44:281-297. [PMID: 38759959 PMCID: PMC11210577 DOI: 10.1055/s-0044-1787046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
This review delves into updates in management of large hemispheric infarction (LHI), a condition affecting up to 10% of patients with supratentorial strokes. While traditional management paradigms have endured, recent strides in research have revolutionized the approach to acute therapies, monitoring, and treatment. Notably, advancements in triage methodologies and the application of both pharmacological and mechanical abortive procedures have reshaped the acute care trajectory for patients with LHI. Moreover, ongoing endeavors have sought to refine strategies for the optimal surveillance and mitigation of complications, notably space-occupying mass effect, which can ensue in the aftermath of LHI. By amalgamating contemporary guidelines with cutting-edge clinical trial findings, this review offers a comprehensive exploration of the current landscape of acute and ongoing patient care for LHI, illuminating the evolving strategies that underpin effective management in this critical clinical domain.
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Affiliation(s)
- Charlene J. Ong
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, Massachusetts
| | - Stefanos Chatzidakis
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jimmy J. Ong
- Department of Neurology, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
- Department of Neurology, Jefferson Einstein Hospital, Philadelphia, Pennsylvania
| | - Steven Feske
- Department of Neurology, Chobanian and Avedisian School of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Neurology, Boston Medical Center, 1 Boston Medical Center PI, Boston, Massachusetts
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Salih MSM, Sethuramachandran A, Bidkar PU, Dey A, R. G, Gunasekaran A, Chandar V. Comparison of Optic Nerve Sheath Diameter (ONSD) Measurements Obtained from USG Before and After Placement of Ventriculoperitoneal Shunt in Obstructive Hydrocephalus as a Surrogate Marker for Adequacy of Shunt Function: A Prospective Observational Study. Asian J Neurosurg 2024; 19:242-249. [PMID: 38974437 PMCID: PMC11226299 DOI: 10.1055/s-0044-1786701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Introduction Optic nerve sheath diameter (ONSD) measured using ultrasonography has been widely used as a surrogate marker of elevated intracranial pressure. However, literature is sparse on the correlation between ONSD and ventriculoperitoneal (VP) shunt function, especially in adults with hydrocephalus. Our study was designed to assess the correlation between ONSD measured using ultrasonography before and 12 hours after VP shunt placement and the success of VP shunt placement assessed using computed tomography (CT) of the brain. Materials and Methods Fifty-one patients between 16 and 60 years of age, with obstructive hydrocephalus scheduled for VP shunt surgery were included in this prospective, observational study. ONSD measurements were obtained from both eyes prior to induction of anesthesia, immediately after the surgery, and at 6, 12, and 24 hours after the surgery. An average of three readings was obtained from each eye. Cerebrospinal fluid (CSF) opening pressure was noted after entry into the lateral ventricle. Noncontrast CT (NCCT) brain was obtained 12 hours after the surgery and was interpreted by the same neurosurgeon for signs of successful VP shunt placement. Results There was a significant reduction in ONSD in the postoperative period compared to ONSD measured preoperatively. The average ONSD (mean ± standard deviation) measured prior to induction of anesthesia, immediately after the surgery, and at 6, 12, and 24 hours after the surgery was 5.71 ± 0.95, 5.20 ± 0.84, 5.06 ± 0.79, 4.90 ± 0.79, and 4.76 ± 0.75 mm, respectively. The mean CSF opening pressure was 19.6 ± 6.9 mm Hg. Postoperative NCCT brain revealed misplacement of the shunt tip in only one patient. Conclusion ONSD measured using ultrasonography may be used as a reliable indicator of VP shunt function in adults with obstructive hydrocephalus.
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Affiliation(s)
- M. S. Mohamed Salih
- Department of Neuroanesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Adinarayanan Sethuramachandran
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Prasanna Udupi Bidkar
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ankita Dey
- Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bathinda, Bathinda, Punjab, India
| | - Gopikrishnan R.
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Adethen Gunasekaran
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vivek Chandar
- Department of Anesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Vishwanathareddy SRS, Reddy M, Mishra RK, Chakrabarti D, Kulanthaivelu K. Transcranial ultrasonographic evaluation of effect of ventriculoperitoneal shunt on intracranial dynamics: A prospective observational study. J Clin Neurosci 2024; 120:163-169. [PMID: 38245979 DOI: 10.1016/j.jocn.2023.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Transcranial sonographic (TCS) evaluation of optic nerve sheath diameter (ONSD), third ventricular diameter (TVD) and mean flow velocities (Vm) and pulsatility index (PI) of middle cerebral artery (MCA) can provide important insights to the change in intracranial dynamics following ventriculo-peritoneal (VP) shunt surgery. The primary objective of this study was to observe changes in ONSD values following VP shunt at 12 h, compared to pre-VP shunt values. METHODS After obtaining ethical approval, patients admitted with a diagnosis of hydrocephalus posted for a VP shunt surgery were prospectively enrolled. TCS evaluation was done before induction of anesthesia and 12-hour post-VP shunt surgery. We recorded the values of ONSD, TVD and Vm and PI MCA at both time points. RESULTS Thirty-four patients (19 male) were evaluated for ONSD and for the improvement of symptoms. Transtemporal window could not be obtained in six patients. At 12 h following VP shunt, bilateral median ONSD values reduced significantly from their pre-VP shunt values [right ONSD- 0.62 (0.59-0.64) to 0.53 (0.5-0.54) mm (p < 0.001); left ONSD- 0.62 (0.59-0.63) to 0.53 (0.5-0.54) mm (p < 0.001)]. Similarly, the median TVD at 12 h post-VP shunt reduced significantly from its pre-VP shunt measurements [0.97 (0.85-1.09) to 0.74 (0.7-0.84) cm]. PI MCA values reduced significantly, while Vm MCA values increased significantly from the pre-VP shunt values. CONCLUSION VP shunt reduced the ONSD, TVD, PI MCA and increased the Vm MCA after shunt surgery as early as 12hrs.
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Affiliation(s)
| | - Madhusudan Reddy
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Rajeeb Kumar Mishra
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, India.
| | - Dhritiman Chakrabarti
- Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Karthik Kulanthaivelu
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Xu J, Song Y, Shah Nayaz BM, Shi W, Zhao Y, Liu Y, Wu S, Li Z, Sun Y, Zhao Y, Yu W, Wang X. Optic Nerve Sheath Diameter Sonography for the Diagnosis of Intracranial Hypertension in Traumatic Brain Injury: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 182:136-143. [PMID: 37951461 DOI: 10.1016/j.wneu.2023.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Timely diagnosis and management of elevated intracranial pressure (ICP) in patients with traumatic brain injury (TBI) can significantly reduce mortality rates. Ultrasound examination of the optic nerve sheath diameter (ONSD) is considered a potential, noninvasive, and effective method for assessing ICP. We conducted a systematic review and meta-analysis of ONSD ultrasound detection and invasive ICP monitoring methods to compare and evaluate the diagnostic accuracy of ONSD ultrasound detection methods for intracranial hypertension (IH) in patients with TBI. METHODS We searched the Web of Science, PubMed, and Embase databases to assess the diagnostic accuracy of ONSD sonography for predicting increased ICP. The 2 authors independently extracted the collected data. Simultaneously, the QUADAS-2 tool was used to evaluate the bias risk of each study and conducted random-effects meta-analyses for the accuracy and specificity of diagnosis, and calculated pooled estimates. RESULTS Ten studies with 512 patients were included. The diagnostic accuracy of ONSD sonography for IH was revealed as a pooled sensitivity of 0.85 (95% confidence interval [CI], 0.79-0.89) and specificity of 0.88 (95% CI, 0.80-0.93), compared with the invasive ICP monitoring standard for patients with TBI. CONCLUSIONS ONSD sonography may be a useful method for predicting increased ICP in adult patients with TBI. Further clinical studies are required to confirm the diagnostic value of ONSD sonography.
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Affiliation(s)
- Jie Xu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China; Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China; Department of Critical Care Medicine, Xuzhou First People's Hospital, Xuzhou, China
| | - Yinghua Song
- Department of Pharmaceutical Engineering, Jiangsu Provincial Xuzhou Pharmaceutical Vocational College, Xuzhou, China
| | - Burkutally Muhammad Shah Nayaz
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science Technology, Wuhan, China
| | - Weitao Shi
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China; Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yun Zhao
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China; Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yawen Liu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China; Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
| | - Suming Wu
- Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhi Li
- Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yanhu Sun
- Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yuliang Zhao
- Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
| | - Wenkui Yu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Nanjing, China
| | - Xudong Wang
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China; Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China.
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Yazici MM, Yavaşi Ö. Effect of a cervical collar on optic nerve sheath diameter in trauma patients. World J Emerg Med 2024; 15:126-130. [PMID: 38476525 PMCID: PMC10925536 DOI: 10.5847/wjem.j.1920-8642.2024.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/17/2023] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND As advocated in advanced trauma life support and prehospital trauma life support protocols, cervical immobilization is applied until cervical spine injury is excluded. This study aimed to show the difference in optic nerve sheath diameter (ONSD) between patients with and without a cervical collar using computed tomography (CT). METHODS This was a single-center, retrospective study examining trauma patients who presented to the emergency department between January 1, 2021, and December 31, 2021. The ONSD on brain CT of the trauma patients was measured and analyzed to determine whether there was a difference between the ONSD with and without the cervical collar. RESULTS The study population consisted of 169 patients. On CT imaging of patients with (n=66) and without (n=103) cervical collars, the mean ONSD in the axial plane were 5.43 ± 0.50 mm and 5.04 ± 0.46 mm respectively for the right eye and 5.50 ± 0.52 mm and 5.11 ± 0.46 mm respectively for the left eye. The results revealed an association between the presence of a cervical collar and the mean ONSD, which was statistically significant (P<0.001) for both the right and left eyes. CONCLUSION A cervical collar may be associated with increased ONSD. The effect of this increase in the ONSD on clinical outcomes needs to be investigated, and the actual need for cervical collar in the emergency department should be evaluated on a case-by-case basis.
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Affiliation(s)
- Mümin Murat Yazici
- Department of Emergency Medicine, Recep Tayyip Erdogan University Training and Research Hospital, Rize 53020, Türkiye
| | - Özcan Yavaşi
- Department of Emergency Medicine, Recep Tayyip Erdogan University Training and Research Hospital, Rize 53020, Türkiye
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Ali A, McCreary DJ. Optic nerve sheath diameter measurement for the paediatric patient with an acute deterioration in consciousness. Ultrasound J 2023; 15:45. [PMID: 38049637 PMCID: PMC10695894 DOI: 10.1186/s13089-023-00341-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/17/2023] [Indexed: 12/06/2023] Open
Abstract
Ocular Point of Care Ultrasound (PoCUS) is emerging as a valuable utility within emergency medicine. Optic nerve sheath diameter (ONSD) has been demonstrated to correlate closely with intracranial pressure (ICP) and an elevated measurement can detect raised ICP readily, where fundoscopy may not, owing to both technical challenges and insufficient clinical skills. A previously fit and well 10-year-old girl presented to the paediatric emergency department with worsening headache, fever and lethargy. On examination, her left pupil was large, and not reactive to light. Initially, her GCS was 15 but suddenly dropped to 8/15. Her blood tests showed raised inflammatory markers. A CT head was reported as possible pansinusitis and MRI of her brain was initially reported as showing evidence of meningeal irritation only. Due to her drop in GCS PoCUS of optic nerve sheath was conducted which showed evidence of increased ICP with increased optic nerve sheath diameter of 6.8mm. This led to a reassessment of the MRI imaging by the neurosurgical team who felt there was evidence of subdural empyema. The patient was transferred to the tertiary neurosurgical centre, where an emergency evacuation of subdural empyema was carried out. Staphylococcus aureus and Streptococcus pyogenes were grown from pus samples. Early detection of raised ICP is of paramount importance in terms of being able to instigate neuroprotective measures and prevent adverse neurological outcomes. PoCUS is a readily available, non-irradiating, easily repeatable, well-tolerated and readily teachable ultrasound modality and a useful tool which should be employed in paediatric and adult emergency departments.
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Affiliation(s)
- Ahmed Ali
- Paediatric Emergency Department, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - David J McCreary
- Paediatric Emergency Department, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK.
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Sohn G, Kim SE. Measurement of thalamus and cortical damages in hypoxic ischemic encephalopathy. IBRO Neurosci Rep 2023; 15:179-185. [PMID: 37731916 PMCID: PMC10507579 DOI: 10.1016/j.ibneur.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/22/2023] Open
Abstract
Background The thalamic gray-white matter ratios (GWRs) on CT and quantitative suppression ratios (SRs) of background activities on EEG may reflect damages in the thalamus and cerebral hemispheres in patients with hypoxic-ischemic encephalopathy (HIE). Methods The inclusion criteria were (1) cardiac arrest patients over the age of 20 years from March 2010 to March 2020, and (2) patients who had both EEG and brain CT within 7 days after cardiac arrest. The thalamic GWRs were semi-quantitatively measured by using the region of interest (ROI). SRs of background were analyzed with the installed software (Persyst® v13) in EEG machine. Results 175 patients were included among 686 patients with HIE and the thalamic GWRs of 168 patients were successfully measured. 155 patients (89 %) showed poor outcomes. The poor outcome group revealed not only higher SRs, but also lower thalamic GWRs. The thalamic GWRs showed a negative correlation to the SRs (ρ (rho) = -0.36, p < 0.0001 for right side, ρ (rho) = -0.31, p < 0.0001 for left side). The good outcome group showed neither beyond the cut-off values of thalamic GWRs nor SRs [40 % (59/148) VS 0 % (0/20) in right side, p = 0.0005 %, and 28 % (42/148) VS 0 % (0/20) in left side, p = 0.0061]. Conclusion The thalamic GWRs and SRs may reflect the damage in the thalamus and cerebral hemispheres in patients with HIE. Insults in the thalamocortical circuit (TCC) or the thalamus might be responsible for the poor outcome.
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Affiliation(s)
| | - Sung Eun Kim
- Correspondence to: Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan 48108, Republic of Korea.
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Hirzallah MI, Bose S, Hu J, Maltz JS. Automation of ultrasonographic optic nerve sheath diameter measurement using convolutional neural networks. J Neuroimaging 2023; 33:898-903. [PMID: 37845814 DOI: 10.1111/jon.13163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND AND PURPOSE Ultrasonographic optic nerve sheath (ONS) diameter is a noninvasive intracranial pressure (ICP) surrogate. ICP is monitored invasively in specialized intensive care units. Noninvasive ICP monitoring is important in less specialized settings. However, noninvasive ICP monitoring using ONS diameter (ONSD) is limited by the need for experts to obtain and perform measurements. We aim to automate ONSD measurements using a deep convolutional neural network (CNN) with a novel masking technique. METHODS We trained a CNN to reproduce masks that mark the ONS. The edges of the mask are defined by an expert. Eight models were trained with 1000 epochs per model. The Dice-similarity-coefficient-weighted averaged outputs of the eight models yielded the final predicted mask. Eight hundred and seventy-three images were obtained from 52 transorbital cine-ultrasonography sessions, performed on 46 patients with brain injuries. Eight hundred and fourteen images from 48 scanning sessions were used for training and validation and 59 images from four sessions for testing. Bland-Altman and Pearson linear correlation analyses were used to evaluate the agreement between CNN and expert measurements. RESULTS Expert ONSD measurements and CNN-derived ONSD estimates had strong agreement (r = 0.7, p < .0001). The expert mean ONSD (standard deviation) is 5.27 mm (0.43) compared to CNN mean estimate of 5.46 mm (0.37). Mean difference (95% confidence interval, p value) is 0.19 mm (0.10-0.27 mm, p = .0011), and root mean square error is 0.27 mm. CONCLUSION A CNN can learn ONSD measurement using masking without image segmentation or landmark detection.
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Affiliation(s)
- Mohammad I Hirzallah
- Departments of Neurology and Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
- Baylor College of Medicine, Center for Space Medicine, Houston, Texas, USA
| | | | - Jingtong Hu
- Department of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Ustick JJ, Pardon LP, Chettry P, Patel NB, Cheng H. Effects of head-down tilt on optic nerve sheath diameter in healthy subjects. Ophthalmic Physiol Opt 2023; 43:1531-1539. [PMID: 37401194 PMCID: PMC10592427 DOI: 10.1111/opo.13200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE Intracranial pressure increases in head-down tilt (HDT) body posture. This study evaluated the effect of HDT on the optic nerve sheath diameter (ONSD) in normal subjects. METHODS Twenty six healthy adults (age 28 [4.7] years) participated in seated and 6° HDT visits. For each visit, subjects presented at 11:00 h for baseline seated scans and then maintained a seated or 6° HDT posture from 12:00 to 15:00 h. Three horizontal axial and three vertical axial scans were obtained at 11:00, 12:00 and 15:00 h with a 10 MHz ultrasonography probe on the same eye, randomly chosen per subject. At each time point, horizontal and vertical ONSD (mm) were quantified by averaging three measures taken 3 mm behind the globe. RESULTS In the seated visit, ONSDs were similar across time (p > 0.05), with an overall mean (standard deviation) of 4.71 (0.48) horizontally and 5.08 (0.44) vertically. ONSD was larger vertically than horizontally at each time point (p < 0.001). In the HDT visit, ONSD was significantly enlarged from baseline at 12:00 and 15:00 h (p < 0.001 horizontal and p < 0.05 vertical). Mean (standard error) horizontal ONSD change from baseline was 0.37 (0.07) HDT versus 0.10 (0.05) seated at 12:00 h (p = 0.002) and 0.41 (0.09) HDT versus 0.12 (0.06) seated at 15:00 h (p = 0.002); mean vertical ONSD change was 0.14 (0.07) HDT versus -0.07 (0.04) seated at 12:00 h (p = 0.02) and 0.19 (0.06) HDT versus -0.03 (0.04) seated at 15:00 h (p = 0.01). ONSD change in HDT was similar between 12:00 and 15:00 h (p ≥ 0.30). Changes at 12:00 h correlated with those at 15:00 h for horizontal (r = 0.78, p < 0.001) and vertical ONSD (r = 0.73, p < 0.001). CONCLUSION The ONSD increased when body posture transitioned from seated to HDT position without any further change at the end of the 3 h in HDT.
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Affiliation(s)
| | - Laura P. Pardon
- University of Houston, College of Optometry, Houston, Texas, USA
| | - Pratik Chettry
- University of Houston, College of Optometry, Houston, Texas, USA
| | - Nimesh B. Patel
- University of Houston, College of Optometry, Houston, Texas, USA
| | - Han Cheng
- University of Houston, College of Optometry, Houston, Texas, USA
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Al Amry M, AlHijji L, Elkhamary SM, Mousa A, AlGaeed A, AlGhadeer H. Optic Nerve Avulsion: Pattern and Etiologies at a Tertiary Eye Care Center in Saudi Arabia: An 8-Year Retrospective Study. Clin Ophthalmol 2023; 17:2633-2641. [PMID: 37701463 PMCID: PMC10493133 DOI: 10.2147/opth.s426493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023] Open
Abstract
Purpose Optic nerve avulsion (ONA) is a rare but serious presentation of ocular trauma. This study investigates the presenting characteristics and etiologies of all cases of ONA over an 8-year-period at a tertiary eye care center in the Middle East. Methods The medical records of patients diagnosed with ONA at an Ophthalmic Emergency Department between November 2014 and November 2022 were analyzed in this retrospective cohort study. Data were collected on patient age, sex, affected eye, cause of injury and imaging studies. The best-corrected visual acuity (BCVA) at presentation and at the last follow-up visit, and the duration of follow-up were documented. Results The study sample was comprised of 44 eyes of 43 patients with ONA with median age of 16.5 (9.3-26.8) years ranging from 2 years old to 70 years old. There were (35;79.5%) males and (9; 20.5%) females. Most cases presented with an affected left eye (27; 61.4%) followed by the right eye (16; 36.4%) and only one patient (2.3%) had bilateral ONA. The most common cause of trauma resulting in ONA was a metallic object (8;18.2%). This study demonstrates the value of multi-sequence Magnetic resonance imaging (MRI) in the setting of unexplained vision loss when other modalities are inadequate or inconclusive. Conclusion Ophthalmic morbidity resulting from ONA can be devastating. Metallic object injuries were the most prevalent cause of ONA. The presence of associated media opacities challenges the initial diagnosis of ONA. In the vast majority of cases, the vision ended as no light perception (NLP), indicating permanent vision impairment.
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Affiliation(s)
- Mohammad Al Amry
- Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Lamia AlHijji
- Ophthalmology Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Sahar M Elkhamary
- Radiology Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Ahmed Mousa
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Abdulrahman AlGaeed
- Radiology Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Huda AlGhadeer
- Emergency Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Moore BT, Osika T, Satterly S, Shah S, Thirion T, Hampton S, Aylward S, Montgomery S. Evaluation of commercially available point-of-care ultrasound for automated optic nerve sheath measurement. Ultrasound J 2023; 15:33. [PMID: 37530991 PMCID: PMC10397168 DOI: 10.1186/s13089-023-00331-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Measurement of the optic nerve sheath diameter (ONSD) via ultrasonography has been proposed as a non-invasive metric of intracranial pressure that may be employed during in-field patient triage. However, first responders are not typically trained to conduct sonographic exams and/or do not have access to an expensive ultrasound device. Therefore, for successful deployment of ONSD measurement in-field, we believe that first responders must have access to low-cost, portable ultrasound and be assisted by artificial intelligence (AI) systems that can automatically interpret the optic nerve sheath ultrasound scan. We examine the suitability of five commercially available, low-cost, portable ultrasound devices that can be combined with future artificial intelligence algorithms to reduce the training required for and cost of in-field optic nerve sheath diameter measurement. This paper is focused on the quality of the images generated by these low-cost probes. We report results of a clinician preference survey and compare with a lab analysis of three quantitative image quality metrics across devices. We also examine the suitability of the devices in a hypothetical far-forward deployment using operators unskilled in ultrasound, with the assumption of a future onboard AI video interpreter. RESULTS We find statistically significant differences in clinician ranking of the devices in the following categories: "Image Quality", "Ease of Acquisition", "Software", and "Overall ONSD". We show differences in signal-to-noise ratio, generalized contrast-to-noise ratio, point-spread function across the devices. These differences in image quality result in a statistically significant difference in manual ONSD measurement. Finally, we show that sufficiently wide transducers can capture the optic nerve sheath during blind (no visible B-mode) scans performed by operators unskilled in sonography. CONCLUSIONS Ultrasound of the optic nerve sheath has the potential to be a convenient, non-invasive, point-of-injury or triage measure for elevated intracranial pressure in cases of traumatic brain injury. When transducer width is sufficient, briefly trained operators may obtain video sequences of the optic nerve sheath without guidance. This data suggest that unskilled operators are able to achieve the images needed for AI interpretation. However, we also show that image quality differences between ultrasound probes may influence manual ONSD measurements.
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Affiliation(s)
- Brad T Moore
- Medical Computing, Kitware, Inc, Carrboro, NC, USA.
| | - Tom Osika
- Medical Computing, Kitware, Inc, Carrboro, NC, USA
| | - Steven Satterly
- Surgical Critical Care, Duke University Health System, Durham, NC, USA
| | - Shreyansh Shah
- Trauma, Acute, and Critical Care Surgery, Duke University Health System, Durham, NC, USA
| | - Tim Thirion
- Medical Computing, Kitware, Inc, Carrboro, NC, USA
| | | | | | - Sean Montgomery
- Neurocritical Care, Duke University Health System, Durham, NC, USA
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Gönen AO, Kaya G, Tütüncü AÇ, Özcan R, Emre Ş, Kendigelen P. Effect of paediatric caudal injection volume on optic nerve sheath diameter and regional cerebral oximetry: A randomised trial. Eur J Anaesthesiol 2023; 40:465-471. [PMID: 36938985 DOI: 10.1097/eja.0000000000001819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
BACKGROUND Caudal injections commonly used for neuraxial anaesthesia in children can displace cerebrospinal fluid cranially causing safety concerns in terms of raised intracranial pressure. Optic nerve sheath diameter (ONSD) is a noninvasive surrogate for the measurement of intracranial pressure. Regional cerebral oximetry (CrSO 2 ) can monitor brain oxygenation, which may decrease by a reduction in cerebral flow due to increased intracranial pressure. OBJECTIVES Comparing how caudal injection volumes of 0.8 and 1.25 ml kg -1 influence ONSD and CrSO 2 within the first 30 min after injection. DESIGN Prospective, randomised and parallel group trial. SETTING Operating room. PATIENTS Fifty-eight elective paediatric surgical patients between ages 1 and 7 years old, ASA class I or II, without previous intracranial or ocular pathology and surgery appropriate for single - shot caudal anaesthesia. INTERVENTION Single-shot caudal anaesthesia with 0.8 ml kg -1 (group L, n = 29) and 1.25 ml kg -1 (group H, n = 29) of 2 mg kg -1 bupivacaine solution. MAIN OUTCOME MEASURES Optic nerve sheath diameter measured with ultrasonography and regional cerebral oximetry measured by near - infrared spectroscopy before (NIRS), immediately after, 10, 20 and 30 min after the block. RESULTS Mean ONSD values increased from a baseline of 4.4 ± 0.2 mm to a maximum of 4.5 ± 0.2 mm 20 min after injection in group L and from a baseline of 4.5 ± 0.3 mm to a maximum of 4.8 ± 0.3 mm 10 min after injection in group H. Eight of 29 patients in group H and none in group L had an ONSD increase by more than 10%. Both groups had a reduction of less than 2.5% in CrSO 2 . CONCLUSION Caudal injection with 1.25 ml kg -1 increased ONSD, an indirect measurement of ICP, more than 0.8 ml kg -1 and neither volume caused a clinically important reduction in CrSO 2 . TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04491032.
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Affiliation(s)
- Aybike Onur Gönen
- From the Department of Anaesthesiology and Intensive Care (AOG, GK, AÇT, PK) and Department of Paediatric Surgery, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Fatih/İstanbul, Türkiye (RÖ, SE)
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Renwick CM, Curley J. Optic Nerve Ultrasound for Monitoring Deteriorating Intracranial Hemorrhage in a Patient on Extracorporeal Membrane Oxygenation: A Case Report. Cureus 2023; 15:e42719. [PMID: 37654933 PMCID: PMC10466261 DOI: 10.7759/cureus.42719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
We present a 52-year-old male patient with cardiogenic shock who was placed on veno-arterial extracorporeal membrane oxygenation (ECMO) as a bridge to an orthotopic heart transplant. While on ECMO, the patient developed an acute intracranial bleed confirmed on computerized tomography (CT). However, his clinical status deteriorated and he was unstable for transport to evaluate for worsening hemorrhage. Instead, optic nerve sheath (ONS) ultrasonography was utilized to confirm increased intracranial pressure, which guided the goals of care until he stabilized enough to transport for advanced imaging. Repeat CT confirmed the worsening of his cerebellar bleed with obstructing hydrocephalus and brainstem compression. This case demonstrates how ONS ultrasound can be utilized in a cardiothoracic intensive care unit to evaluate sedated patients for new or worsening intracranial hemorrhage. In ECMO patients, who are often unstable with the risks of transportation for CT outweighing potential benefits, ONS ultrasonography can provide the care team with meaningful data on a patient's neurologic status.
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Affiliation(s)
- Christian M Renwick
- Anesthesiology and Critical Care, University of Virginia, Charlottesville, USA
| | - Jonathan Curley
- Anesthesiology and Critical Care, University of Virginia, Charlottesville, USA
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Kappagantu V, Sinha TP, Agrawal D, Jamshed N, Kumar A, Kumar A, Pandey RM, Gopinath B, Bhushan V, Tiwari AK, Bhoi SK. Diagnostic Accuracy of Ocular Ultrasonography in Identifying Raised Intracranial Pressure among Pediatric Population. Pediatr Neurosurg 2023; 58:142-149. [PMID: 37231881 DOI: 10.1159/000530921] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/11/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Role of CT scan, MRI, ophthalmoscopy, direct monitoring by a transducer probe in identifying raised intracranial pressure (ICP) in emergency department is limited. There are few studies correlating elevated optic nerve sheath diameter (ONSD) measured by point of care ultrasound (POCUS) with raised ICP in pediatrics emergencies. We studied the diagnostic accuracy of ONSD, crescent sign, and optic disc elevation in identifying increased ICP in pediatrics. METHODS Prospective observational study was done between April 2018 and August 2019 after ethics approval. Out of 125 subjects, 40 patients without clinical features of raised ICP were recruited as external controls and 85 with clinical features of raised ICP as study subjects. Their demographic profile, clinical examination, and ocular ultrasound findings were noted. This was followed by CT scan. Out of 85 patients, 43 had raised ICP (cases) and 42 had normal ICP (disease controls). Diagnostic accuracy of ONSD in identifying raised ICP was evaluated using STATA. RESULTS The mean ONSD in case group was 5.5 ± 0.6 mm, 4.9 ± 0.5 mm in disease control group and external control group was 4.8 ± 0.3 mm. Cut-off of ONSD for raised ICP at ≥4.5 mm had a sensitivity and specificity of 97.67% and 10.98%, while ≥5.0 mm showed a sensitivity and specificity of 86.05% and 71.95%. Crescent sign and optic disc elevation had good correlation with increased ICP. CONCLUSION ONSD ≥5 mm by POCUS identified raised ICP in pediatric population. Crescent sign and optic disc elevation may function as additional POCUS signs in identifying raised ICP.
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Affiliation(s)
- Vignan Kappagantu
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tej Prakash Sinha
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nayer Jamshed
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Bharath Gopinath
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vidhya Bhushan
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kumar Tiwari
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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Yang B, Li M, Liang J, Tang X, Chen Q. Effect of internal jugular vein catheterization on intracranial pressure and postoperative cognitive function in patients undergoing robot-assisted laparoscopic surgery. Front Med (Lausanne) 2023; 10:1199931. [PMID: 37215728 PMCID: PMC10192865 DOI: 10.3389/fmed.2023.1199931] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/19/2023] [Indexed: 05/24/2023] Open
Abstract
Background We aimed to evaluate the effects of internal jugular vein (IJV) catheterization on intracranial pressure (ICP) and postoperative delirium (POD) during robot-assisted laparoscopic surgery by measuring the optic nerve sheath diameter (ONSD). Methods Data from a prospective single-center cohort study, conducted from October 2021 to February 2022, were used. Forty out of 80 patients scheduled for laparoscopic radical hysterectomy or prostatectomy were assigned to the group receiving IJV catheterization (Group I), and the other 40 only received peripheral venous cannulation (Group C) according to clinical need of patients. Ultrasonography of ONSDs, the proportion of regurgitation time in a cardiac cycle, and hemodynamic parameters were measured at four time points: immediately after induction of anesthesia in the supine position (T0), 30 min (T1), 60 min (T2) after orienting to the Trendelenburg position, and before returning to the supine position at the end of surgery (T3). Time to eye opening and emergence stay, POD, and QoR-15 were compared. Results The ONSDs increase gradually as the surgery progressed. Group I showed a higher value of ONSD at T1 (4.72 ± 0.29 mm vs. 4.5 ± 0.33 mm, p = 0.0057) and T3 (5.65 ± 0.33 mm vs. 5.26 ± 0.31 mm, p < 0.0001). The proportions of the regurgitation time of IJVV were greater in Group I than those in Group C at T1 (14.95, 8.5%-18.9% vs. 9.6%, 0%-17.2%, p < 0.0001) and T3 (14.3, 10.6%-18.5% vs. 10.4%, 0%-16.5%, p = 0.0003). Group I had a delayed time to eye opening (10.7 ± 1.72 min vs. 13.3 ± 2.35 min, p < 0.0001) and emergence stay (32.2 ± 5.62 min vs. 39.9 ± 6.7 min, p < 0.0001). There were no significant differences in POD and QoR-15 between the two groups on day three. Conclusion IJV cannulation may not be the preferred approach in robot-assisted laparoscopic surgery as it was risk factor for IJVV regurgitation, ICP elevation, emergence delayed.
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Affiliation(s)
- Bin Yang
- School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, China
- Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Min Li
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Jingqiu Liang
- Chongqing Cancer Multi-omics Big Data Application Engineering Research Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Xixi Tang
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Qi Chen
- Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China
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Uttanganakam S, Hansda U, Sahoo S, Shaji IM, Guru S, Topno N, Sahoo NK. Sonographic Optic Nerve Sheath Diameter as a Guide for Correction of Hyponatremia in the Emergency Department: A Cross-sectional Study. Indian J Crit Care Med 2023; 27:265-269. [PMID: 37378026 PMCID: PMC10291655 DOI: 10.5005/jp-journals-10071-24438] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/20/2023] [Indexed: 08/30/2024] Open
Abstract
BACKGROUND Monitoring sodium levels during the correction of hyponatremia is essential. There is cell swelling due to the movement of water from extracellular to intracellular by osmotic effect in hyponatremia. The cellular swelling in a closed space causes increased intracranial pressure (ICP). The raised ICP correlates with the optic nerve sheath diameter (ONSD). So, the research question was whether the ONSD can be used as a guide for the correction of hyponatremia. METHODS It was a prospective observational study conducted on patients with serum sodium below 135 mEq/L presented to the emergency department (ED). The ONSD was measured at the time of presentation and discharge of the patient. The receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to test the predictive ability of the ONSD to diagnose hyponatremia. RESULTS A total of 54 subjects were included in the study. The mean sodium level was 109.3 mEq/L at presentation. The mean ONSD on the right side was 6.24 ± 0.71 mm and on the left side was 6.26 ± 0.64 mm at presentation to ED. The mean ONSD on the right side was 5.81 ± 0.58 mm and on the left side was 5.79 ± 0.56 mm at discharge. The ONSD was not able to predict the sodium level measured both by laboratory and POC methods. CONCLUSION The ONSD failed to predict the sodium level in patients with hyponatremia during the correction. The change in ONSD did not correlate with the change in sodium level. HOW TO CITE THIS ARTICLE Uttanganakam S, Hansda U, Sahoo S, Shaji IM, Guru S, Topno N, et al. Sonographic Optic Nerve Sheath Diameter as a Guide for Correction of Hyponatremia in the Emergency Department: A Cross-sectional Study. Indian J Crit Care Med 2023;27(4):265-269.
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Affiliation(s)
- Sanjeed Uttanganakam
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Upendra Hansda
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sangeeta Sahoo
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Ijas Muhammed Shaji
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Satyabrata Guru
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nitish Topno
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Nishit Kumar Sahoo
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Arunachala S. Optic Nerve Sheath Diameter and Sodium Levels: A Friend of a Friend is Still a Stranger. Indian J Crit Care Med 2023; 27:235-236. [PMID: 37378036 PMCID: PMC10291647 DOI: 10.5005/jp-journals-10071-24444] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 03/25/2023] [Indexed: 09/22/2024] Open
Abstract
How to cite this article: Arunachala S. Optic Nerve Sheath Diameter and Sodium Levels: A Friend of a Friend is Still a Stranger. Indian J Crit Care Med 2023;27(4):235-236.
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Affiliation(s)
- Sumalatha Arunachala
- Department of Critical Care, Clearmedi Radiant Hospital, Mysuru, Karnataka, India
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Kelly AM. Direct ophthalmoscopy in the evaluation of emergency department patients with headache: Time to rethink? Emerg Med Australas 2023; 35:357-358. [PMID: 36628956 DOI: 10.1111/1742-6723.14176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/12/2023]
Affiliation(s)
- Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
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Weber MD, Lim JKB, Ginsburg S, Conlon T, Nishisaki A. Translating Guidelines into Practical Practice: Point-of-Care Ultrasound for Pediatric Critical Care Clinicians. Crit Care Clin 2023; 39:385-406. [PMID: 36898781 DOI: 10.1016/j.ccc.2022.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Point-of-care ultrasound (POCUS) is now transitioning from an emerging technology to a standard of care for critically ill children. POCUS can provide immediate answers to clinical questions impacting management and outcomes within this fragile population. Recently published international guidelines specific to POCUS use in neonatal and pediatric critical care populations now complement previous Society of Critical Care Medicine guidelines. The authors review consensus statements within guidelines, identify important limitations to statements, and provide considerations for the successful implementation of POCUS in the pediatric critical care setting.
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Affiliation(s)
- Mark D Weber
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA.
| | - Joel K B Lim
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore
| | - Sarah Ginsburg
- Division of Critical Care Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Thomas Conlon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Akira Nishisaki
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA 19104, USA
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Abstract
OBJECTIVES Critically ill patients are at high risk of acute brain injury. Bedside multimodality neuromonitoring techniques can provide a direct assessment of physiologic interactions between systemic derangements and intracranial processes and offer the potential for early detection of neurologic deterioration before clinically manifest signs occur. Neuromonitoring provides measurable parameters of new or evolving brain injury that can be used as a target for investigating various therapeutic interventions, monitoring treatment responses, and testing clinical paradigms that could reduce secondary brain injury and improve clinical outcomes. Further investigations may also reveal neuromonitoring markers that can assist in neuroprognostication. We provide an up-to-date summary of clinical applications, risks, benefits, and challenges of various invasive and noninvasive neuromonitoring modalities. DATA SOURCES English articles were retrieved using pertinent search terms related to invasive and noninvasive neuromonitoring techniques in PubMed and CINAHL. STUDY SELECTION Original research, review articles, commentaries, and guidelines. DATA EXTRACTION Syntheses of data retrieved from relevant publications are summarized into a narrative review. DATA SYNTHESIS A cascade of cerebral and systemic pathophysiological processes can compound neuronal damage in critically ill patients. Numerous neuromonitoring modalities and their clinical applications have been investigated in critically ill patients that monitor a range of neurologic physiologic processes, including clinical neurologic assessments, electrophysiology tests, cerebral blood flow, substrate delivery, substrate utilization, and cellular metabolism. Most studies in neuromonitoring have focused on traumatic brain injury, with a paucity of data on other clinical types of acute brain injury. We provide a concise summary of the most commonly used invasive and noninvasive neuromonitoring techniques, their associated risks, their bedside clinical application, and the implications of common findings to guide evaluation and management of critically ill patients. CONCLUSIONS Neuromonitoring techniques provide an essential tool to facilitate early detection and treatment of acute brain injury in critical care. Awareness of the nuances of their use and clinical applications can empower the intensive care team with tools to potentially reduce the burden of neurologic morbidity in critically ill patients.
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Affiliation(s)
- Swarna Rajagopalan
- Department of Neurology, Cooper Medical School of Rowan University, Camden, NJ
| | - Aarti Sarwal
- Department of Neurology, Atrium Wake Forest School of Medicine, Winston-Salem, NC
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Duyan M, Saridas A. Relation between partial arterial carbon dioxide pressure and pH value and optic nerve sheath diameter: a prospective self-controlled non-randomized trial study. J Ultrasound 2023; 26:107-116. [PMID: 35511351 PMCID: PMC10063762 DOI: 10.1007/s40477-022-00677-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 03/14/2022] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE This study aims to determine if there is a correlation between differences in optic nerve sheath diameter (ONSD) and changes in PaCO2 and pH values that were measured in the arterial blood gas (ABG) before and after treatment in COPD patients with acute hypercarbic respiratory failure (AHRF). MATERIALS AND METHODS This study serves as a prospective self-controlled non-randomized trial study conducted in the emergency clinic of a tertiary hospital. Forty-four patients with COPD, who were found to have acidosis and hypercarbia in ABG and had an indication for non-invasive mechanic ventilation (NIMV), were analyzed prospectively. Demographic information, vital findings, initial ABG values, the ONSD measurement (before the NIMV treatment), consciousness state, and the ABG results obtained in the second hour of the monitoring and the ONSD measurement (after the NIMV treatment) were recorded. RESULTS In this study, 13 (29.5%) of the patients were female and 31 (70.5%) were male. The age distribution was evaluated as 68.3 ± 9.2 years; the minimum age was 54 and the maximum was 91. A high level of positively significant correlation was found between the mean ONSD and PaCO2 (p < 0.0001). There is a high fit (0.72) between the mean ONSD and PaCO2. A moderate level of negatively significant correlation was found between the mean ONSD and the pH (p < 0.0001). However, there is an insignificant low fit (0.32) between the mean ONSD and the pH. CONCLUSION The ONSD changed significantly and in a highly correlated manner to acute changes in PaCO2 levels.
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Affiliation(s)
- Murat Duyan
- Department of Emergency Medicine, Emergency Medicine Specialist, Antalya Training and Research Hospital, Varlik District, Kazim Karabekir Street, 07100 Antalya, Turkey
| | - Ali Saridas
- Department of Emergency Medicine, Emergency Medicine Specialist, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
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Hansen HC, Jansen O, Helmke K. [Clinical and sonographic work-up of headache accompanied by unilateral visual afferent and efferent deficits]. Med Klin Intensivmed Notfmed 2023; 118:160-162. [PMID: 36525056 DOI: 10.1007/s00063-022-00979-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/14/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Hans-Christian Hansen
- Klinik für Neurologie, Friedrich-Ebert-Krankenhaus Neumünster GmbH, 24534, Neumünster, Deutschland.
- Universität Hamburg, Hamburg, Deutschland.
| | - Olav Jansen
- Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, 24105, Kiel, Deutschland
| | - Knut Helmke
- Pädiatrische Radiologie, Univ.-Krankenhaus Hamburg Eppendorf, Universität Hamburg, 20246, Hamburg, Deutschland
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Lau T, Ahn JS, Manji R, Kim DJ. A Narrative Review of Point of Care Ultrasound Assessment of the Optic Nerve in Emergency Medicine. Life (Basel) 2023; 13:life13020531. [PMID: 36836888 PMCID: PMC9962087 DOI: 10.3390/life13020531] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/05/2023] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
Point of care ultrasound (POCUS) of the optic nerve is easy to learn and has great diagnostic potential. Within emergency medicine, research has primarily focused on its use for the assessment of increased intracranial pressure, but many other applications exist, though the literature is heterogeneous and largely observational. This narrative review describes the principles of POCUS of the optic nerve including anatomy and scanning technique, as well as a summary of its best studied clinical applications of relevance in emergency medicine: increased intracranial pressure, idiopathic intracranial hypertension, optic neuritis, acute mountain sickness, and pediatric intracranial pressure assessment. In many of these applications, sonographic optic nerve sheath diameter (ONSD) has moderately high sensitivity and specificity, but the supporting studies are heterogeneous. Further studies should focus on standardization of the measurement of ONSD, establishment of consistent diagnostic thresholds for elevated intracranial pressure, and automation of ONSD measurement.
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Affiliation(s)
- Torey Lau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Justin S. Ahn
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Emergency Medicine, Royal Columbian Hospital, New Westminster, BC V3L 3W7, Canada
| | - Rahim Manji
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Emergency Medicine, St. Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Daniel J. Kim
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Department of Emergency Medicine, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
- Correspondence: ; Tel.: +1-604-875-4855
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Optic Nerve Ultrasound Evaluation in Children: A Review. Diagnostics (Basel) 2023; 13:diagnostics13030535. [PMID: 36766639 PMCID: PMC9914511 DOI: 10.3390/diagnostics13030535] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/29/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Managing patients with neurocritical illness requires monitoring and treating elevated intracranial pressure (ICP), especially in cases in children. In terms of precise and real-time measurements, invasive ICP measurements are presently the gold standard for the initial diagnosis and follow-up ICP assessments. As a rapid and non-invasive way to detect elevated ICP, point-of-care ultrasonography (POCUS) of optic nerve sheath diameter (ONSD) has been proposed. The utility of bedside POCUS of ONSD to detect elevated ICP with excellent diagnostic test accuracy in adults has already been demonstrated. Nonetheless, data on the relationship between POCUS of ONSD and ICP in children are scarce. Therefore, the purpose of this review is to point out the most recent findings from the pediatric published literature and briefly discuss what was assessed with ONSD ultrasound examination, and also to describe and discuss the diagnostic procedures available for optic nerve ultrasound appraisal. A search of the medical databases PubMed and Scopus was carried out. The terms such as "ocular ultrasonography", "ICP assessment", "children", "point-of-care ultrasound", and "POCUS" were searched. In conclusion, the use of the standardized A-scan technique coupled with the B-scan technique should be suggested to provide data that are as accurate, precise, repeatable, and objective as possible.
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Bhide M, Singh O, Juneja D, Goel A. Bedside ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure in nontraumatic neuro-critically ill patients. World J Crit Care Med 2023; 12:10-17. [PMID: 36683966 PMCID: PMC9846868 DOI: 10.5492/wjccm.v12.i1.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/05/2022] [Accepted: 12/23/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Delay in treatment of raised intracranial pressure (ICP) leads to poor clinical outcomes. Optic nerve sheath diameter (ONSD) by ultrasonography (US-ONSD) has shown good accuracy in traumatic brain injury and neurosurgical patients to diagnose raised ICP. However, there is a dearth of data in neuro-medical intensive care unit (ICU) where the spectrum of disease is different. AIM To validate the diagnostic accuracy of ONSD in non-traumatic neuro-critically ill patients. METHODS We prospectively enrolled 114 patients who had clinically suspected raised ICP due to non-traumatic causes admitted in neuro-medical ICU. US-ONSD was performed according to ALARA principles. A cut-off more than 5.7 mm was taken as significantly raised. Raised ONSD was corelated with raised ICP on radiological imaging. Clinical history, general and systemic examination findings, SOFA and APACHE 2 score and patient outcomes were recorded. RESULTS There was significant association between raised ONSD and raised ICP on imaging (P < 0.001). The sensitivity, specificity, positive and negative predictive value at this cut-off was 77.55%, 89.06%, 84.44% and 83.82% respectively. The positive and negative likelihood ratio was 7.09 and 0.25. The area under the receiver operating characteristic curves was 0.844. Using Youden's index the best cut off value for ONSD was 5.75 mm. Raised ONSD was associated with lower age (P = 0.007), poorer Glasgow Coma Scale (P = 0.009) and greater need for surgical intervention (P = 0.006) whereas no statistically significant association was found between raised ONSD and SOFA score, APACHE II score or ICU mortality. Our limitations were that it was a single centre study and we did not perform serial measurements or ONSD pre- and post-treatment or procedures for raised ICP. CONCLUSION ONSD can be used as a screening a test to detect raised ICP in a medical ICU and as a trigger to initiate further management of raised ICP. ONSD can be beneficial in ruling out a diagnosis in a low-prevalence population and rule in a diagnosis in a high-prevalence population.
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Affiliation(s)
- Madhura Bhide
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Omender Singh
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Deven Juneja
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Amit Goel
- Institute of Critical Care Medicine, Max Super Speciality Hospital, Saket, New Delhi 110017, India
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Caballero-Lozada AF, Miño-Bernal JF, Espinosa-Marsiglia RA, Rojas-Rincón V. Correlation between the Optic Nerve Sheath Diameter Measurement and Intracranial Hypertension Tomographic Findings from a Colombian Hospital. ARQUIVOS BRASILEIROS DE NEUROCIRURGIA: BRAZILIAN NEUROSURGERY 2022. [DOI: 10.1055/s-0041-1740174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Objective In the present study, we aimed at determining the correlation between tomographic findings of intracranial hypertension and ultrasound measurement of the optic nerve sheath diameter (ONSD).
Methods Observational, descriptive, prospective, cross-sectional pilot study. The present research was performed in a tertiary hospital in Cali, Colombia, from March 2019 to October 2019. Twenty-five patients constituted the intracranial hypertension group, and 25 patients without intracranial hypertension constituted the control group. Ultrasound measurements of the ONSD were assessed using a Sonosite Turbo (SonoSite Inc., Bothell, WA, USA) ultrasound. The computed tomography (CT) images obtained from each patient diagnosed with intracranial hypertension were available in the software of the hospital. The primary outcome was the ultrasound measurement of the ONSD.
Results The ONSD values of the right eye of the intracranial hypertension group ranged from 5.2 to 7.6 mm, and the ONSD of the left eye ranged from 5.3 to 7.3 mm. The global ONSD values, obtained from the average between the right and left eye, were recorded between 5.25 and 7.45 mm. Overall, our study indicated that ultrasound measurements of the ONSD were effective in differentiating a group with intracranial hypertension, previously diagnosed by CT scan images, from patients without this condition. According to the ROC curve, the optimal cutoff point for detecting intracranial hypertension was 5.2 mm.
Conclusions Ultrasound measurements of the ONSD correlated with the measurements obtained from CT scan images, suggesting that the ultrasound technique can be efficient in identifying patients with intracranial hypertension and valuable in cases when CT scan images are not an available option.
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Affiliation(s)
- Andrés Fabricio Caballero-Lozada
- Department of Anesthesiology and Resuscitation, Universidad del Valle, Cali, Colombia
- Department of Anesthesiology, Hospital Universitario del Valle, Cali, Colombia
- Fundación Hospital San José de Buga, Buga, Colombia
- Department of Anesthesiology, Unidad Central del Valle del Cauca, Tuluá, Colombia
| | | | - Rene Alberto Espinosa-Marsiglia
- Department of Anesthesiology and Resuscitation, Universidad del Valle, Cali, Colombia
- Department of Anesthesiology, Hospital Universitario del Valle, Cali, Colombia
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Galust H, Banks S, Riscinti M. Point-of-care ultrasound in the detection of central retinal artery occlusion in a patient with recent COVID-19. J Am Coll Emerg Physicians Open 2022; 3:e12842. [PMID: 36381482 PMCID: PMC9660847 DOI: 10.1002/emp2.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Ocular emergencies are a frequent occurrence in the emergency setting. Fortunately, point-of-care ultrasound (POCUS) lends itself exceptionally well to ocular evaluation. Here, we present a unique case of central retinal artery occlusion rapidly diagnosed with POCUS in a patient with a recent COVID-19 diagnosis.
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Affiliation(s)
- Henrik Galust
- Denver Health Residency in Emergency MedicineDenverColoradoUSA
| | - Sarah Banks
- Denver Health Residency in Emergency MedicineDenverColoradoUSA
| | - Mathew Riscinti
- Denver Health Residency in Emergency MedicineDenverColoradoUSA
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Fall DA, Lee AG, Bershad EM, Kramer LA, Mader TH, Clark JB, Hirzallah MI. Optic nerve sheath diameter and spaceflight: defining shortcomings and future directions. NPJ Microgravity 2022; 8:42. [PMID: 36202836 PMCID: PMC9537149 DOI: 10.1038/s41526-022-00228-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/12/2022] [Indexed: 11/24/2022] Open
Abstract
Neuro-ocular changes during long-duration space flight are known as spaceflight-associated neuro-ocular syndrome (SANS). The ability to detect, monitor, and prevent SANS is a priority of current space medicine research efforts. Optic nerve sheath diameter (ONSD) measurement has been used both terrestrially and in microgravity as a proxy for measurements of elevated intracranial pressure. ONSD shows promise as a potential method of identifying and quantitating neuro-ocular changes during space flight. This review examines 13 studies measuring ONSD and its relationship to microgravity exposure or ground-based analogs, including head-down tilt, dry immersion, or animal models. The goal of this correspondence is to describe heterogeneity in the use of ONSD in the current SANS literature and make recommendations to reduce heterogeneity in future studies through standardization of imaging modalities, measurement techniques, and other aspects of study design.
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Affiliation(s)
- Dylan A Fall
- Baylor College of Medicine and The Center for Space Medicine, Houston, TX, USA
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA.,Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, USA.,Department of Ophthalmology, Weill Cornell Medicine, New York, NY, USA.,Department of Ophthalmology, University of Texas Medical Branch, Galveston, TX, USA.,University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Texas A and M College of Medicine, Bryan, TX, USA
| | - Eric M Bershad
- Baylor College of Medicine and The Center for Space Medicine, Houston, TX, USA.,Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Larry A Kramer
- Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center, Houston, USA
| | | | - Jonathan B Clark
- Baylor College of Medicine and The Center for Space Medicine, Houston, TX, USA
| | - Mohammad I Hirzallah
- Baylor College of Medicine and The Center for Space Medicine, Houston, TX, USA. .,Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
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Momtaz OM, Said OM, Mohamed AM, Abdel Mawla TS. Value of Optic Nerve Sheath Diameter in Diagnosis and Follow Up of Patients with Disturbed Conscious Level. Eye Brain 2022; 14:115-126. [PMID: 36193222 PMCID: PMC9526430 DOI: 10.2147/eb.s369813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Background Ultrasonographic measurement of optic nerve sheath diameter is a simple, non-invasive, and reliable method of detecting elevated intracranial pressure (ICP) in critical patients. Optic nerve sheath communicates with the dura mater covering the brain and contains cerebrospinal fluid, allowing pressure transmission from the cranium. Therefore, changes in cerebrospinal fluid (CSF) pressure have been shown to produce changes in ONSD. Objective This study aimed to assess the accuracy of optic nerve sheath diameter (ONSD) in diagnosis and follow-up patients with disturbed conscious levels compared with CT brain and fundus examination. Patients and Methods One hundred forty-one participants were included in the study, classified into 76 cases admitted with disturbed conscious levels due to elevated ICP and 65 controls. All patients were subjected to CT brain and optic nerve US and fundus examination at the time of admission and follow-up after 48 h after proper management. Results The current study showed that ONSD is significant in predicting elevated ICP at the cut-off point of average ONSD of 5.19 mm with 97% sensitivity and 98% specificity, and the area under the curve (AUC) was 0.996. The present study revealed a significant inverse correlation between ONSD and GCS in patients with increased ICP. Conclusion Ultrasonic measurement of ONSD is a promising technique in diagnosing and following patients with disturbed conscious levels.
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Affiliation(s)
| | - Omar M Said
- Ophthalmology Department, Fayoum University, Fayoum, Egypt
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Benhur A, Sharma J, Karna ST, Shrivastava A, Saigal S, Waindeskar VV. Analysis of dynamic changes in optic nerve sheath diameter (ONSD) with ultrasound in post-craniotomy patients: Trends and correlation with computed tomography ONSD and Glasgow coma scale in post-operative period. J Neurosci Rural Pract 2022; 13:676-683. [PMID: 36743767 PMCID: PMC9893949 DOI: 10.25259/jnrp-2022-3-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 09/20/2022] [Indexed: 12/05/2022] Open
Abstract
Objectives Intracranial pressure (ICP) monitoring in patients with intracranial tumors undergoing craniotomy is usually done in perioperative period in intensive care unit. Invasive measurement of ICP, though considered as the gold standard, has its own limitations such as availability of expertise, equipment, and associated complications. Period of raised ICP in post-operative period may impact patient outcomes. Post-craniotomy computed tomography (CT) assessment is done routinely and may need to be repeated if indicated during post-operative stay. Utility of sonographic serial optic nerve sheath diameter (ONSD) assessment in post-operative monitoring of patients who have undergone elective craniotomy was explored in this study. The primary objective of the study was to measure the dynamic change in ONSD as compared to baseline pre-operative measurement in the first 3 postoperative days after elective craniotomy. The secondary objective of the study was to evaluate correlation between ONSD value with Glasgow Coma Scale (GCS) and post-operative CT findings. Materials and Methods In this prospective, observational, and cohort study, we studied adult patients undergoing craniotomy for intracranial tumors. GCS assessment and sonographic measurement of ONSD were done preoperatively, immediate post-operative period, and 12, 24, and 48 h after surgery. CT scan to detect raised ICP was done at 24 h post-operative. Correlation of ONSD with GCS at respective period and correlation of CT scan finding with respective ONSD assessment were evaluated. Results A total of 57 patients underwent elective craniotomy for intracranial tumors. Significant difference was observed in ONSD value depending on time of measurement perioperatively (χ2 = 78.9, P = 0.00). There was initial increase in the first 12 h followed by decrease in ONSD in the next 48 h. Negative correlation was observed between baseline ONSD and 12 h GCS (ρ = -0.345, P = 0.013). There was significant change in GCS scores based on the status of ONSD (raised or normal) at 12 h after surgery (P = 0.014). Significant correlation between USG ONSD and CT ONSD was observed (ρ = 0.928, P = 0.000). Optimal cutoff value of ONSD to detect raised ICP with reference to CT signs was 4.8 mm with 80% sensitivity and 95% specificity. Conclusion ONSD undergoes dynamic changes, correlates with CT scan, and has good diagnostic accuracy to detect raised ICP post-craniotomy for intracranial tumors. It may serve as a useful tool in monitoring in resource-limited setup.
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Affiliation(s)
- Allan Benhur
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Jaiprakash Sharma
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Sunaina Tejpal Karna
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Adesh Shrivastava
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Saurabh Saigal
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Vaishali Vasant Waindeskar
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Hirzallah MI, Lochner P, Hafeez MU, Lee AG, Krogias C, Dongarwar D, Manchanda R, Ouellette L, Hartman ND, Ertl M, Schlachetzki F, Robba C. Quality assessment of optic nerve sheath diameter ultrasonography: Scoping literature review and Delphi protocol. J Neuroimaging 2022; 32:808-824. [PMID: 35711135 DOI: 10.1111/jon.13018] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/06/2022] [Accepted: 06/06/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE The optic nerve is surrounded by the extension of meningeal coverings of the brain. When the pressure in the cerebrospinal fluid increases, it causes a distention of the optic nerve sheath diameter (ONSD), which allows the use of this measurement by ultrasonography (US) as a noninvasive surrogate of elevated intracranial pressure. However, ONSD measurements in the literature have exhibited significant heterogeneity, suggesting a need for consensus on ONSD image acquisition and measurement. We aim to establish a consensus for an ONSD US Quality Criteria Checklist (ONSD US QCC). METHODS A scoping systematic review of published ultrasound ONSD imaging and measurement criteria was performed to guide the development of a preliminary ONSD US QCC that will undergo a modified Delphi study to reach expert consensus on ONSD quality criteria. The protocol of this modified Delphi study is presented in this manuscript. RESULTS A total of 357 ultrasound studies were included in the review. Quality criteria were evaluated under five categories: probe selection, safety, positioning, image acquisition, and measurement. CONCLUSIONS This review and Delphi protocol aim to establish ONSD US QCC. A broad consensus from this process may reduce the variability of ONSD measurements in future studies, which would ultimately translate into improved ONSD clinical applications. This protocol was reviewed and endorsed by the German Society of Ultrasound in Medicine.
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Affiliation(s)
- Mohammad I Hirzallah
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
- Center for Space Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | | | - Andrew G Lee
- Department of Ophthalmology, Houston Methodist Hospital, Houston, Texas, USA
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Christos Krogias
- Department of Neurology, St Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Deepa Dongarwar
- Institutional Diversity & Student Services, Baylor College of Medicine, Houston, Texas, USA
| | - Ramneek Manchanda
- Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | | | - Nicholas D Hartman
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Michael Ertl
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Felix Schlachetzki
- Department of Neurology, Center for Vascular Neurology and Intensive Care, University of Regensburg, Regensburg, Germany
| | - Chiara Robba
- Department of Anesthesia and Intensive Care, Policlinico San Martino, Genova, Italy
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Suresh V, Ushakumari PR, Aggarwal A, Kumar A, Kutty RK, Prabhakar RB, Peethambaran A. Perioperative Variation in Optic Nerve Sheath Diameter - A Prospective Observational Study of Traumatic Brain Injury Patients Undergoing Decompressive Craniectomy. Neurol India 2022; 70:1460-1467. [PMID: 36076644 DOI: 10.4103/0028-3886.355178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Measuring optic nerve sheath diameter (ONSD) by transbulbar ultrasonography (TBUS) can suffice non-invasive ICP measurement with considerable accuracy. Objective The primary objective of this study was to evaluate the perioperative variation in ONSD by TBUS in Traumatic Brain Injury (TBI) patients undergoing emergency craniectomy. Methods We prospectively compared bilateral ONSD measurements in 45 consecutive TBI cases undergoing decompressive craniectomy under general anesthesia; before and after surgery. A total of 180 ONSD images were obtained and measurements were done by the same investigator blinded to the pre/postoperative nature of the image. Results Based on preoperative Glasgow Coma Scores, 34 cases (75.5%) had severe TBI; 10 cases (22.2%) moderate TBI; and 1 case (2.2%) mild TBI. Preoperative ONSD in the study population were as 6.625 ± 0.414mm. Average ONSD reduced significantly by 0.249 ± 0.148 mm (P < 0.001) after craniectomy. On pooled analysis of cases undergoing right versus left sided craniectomy average ONSD reduced significantly by 0.252 ± 0.173 mm (P < 0.001) and 0.259 ± 0.139 mm (P < 0.001), respectively. ONSD of right eye with left eye and vice-versa were strongly correlated both pre/postoperatively with Pearson correlation coefficients (r)=0.879 (P < 0.001) and r = 0.827 (P < 0.001), respectively. Conclusions In TBI cases undergoing decompressive craniectomy ONSD is bilaterally increased preoperatively. ONSD reduces significantly immediately after craniectomy; however, the diameters did not near the normal range. There hold a strong correlation between right/left ONSD measurements irrespective of the laterality of injury or side of surgery. Variable elastic properties of ONS in an injured brain can possibly explain our findings.
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Affiliation(s)
- Varun Suresh
- Department of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - P R Ushakumari
- Department of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Anurag Aggarwal
- Department of Neuroanesthesia and Pain Medicine, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Arun Kumar
- Department of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Raja K Kutty
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Rajmohan B Prabhakar
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Anilkumar Peethambaran
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
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New applications of perioperative POCUS: beyond the Big 4. Int Anesthesiol Clin 2022; 60:65-73. [PMID: 35670237 DOI: 10.1097/aia.0000000000000364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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Hansen HC, Helmke SS, Helmke K. Time course of optic nerve sheath dilation: In vitro response characteristics to controlled pressure elevations. J Neurol Sci 2022; 441:120358. [DOI: 10.1016/j.jns.2022.120358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 07/04/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022]
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50
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Dağdelen K, Ekici M. Measuring optic nerve sheath diameter using ultrasonography in patients with idiopathic intracranial hypertension. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:580-585. [PMID: 35613208 PMCID: PMC9387182 DOI: 10.1590/0004-282x-anp-2021-0136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/13/2021] [Accepted: 08/15/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is primarily a disorder of obese young women characterized by symptoms associated with raised intracranial pressure in the absence of a space-occupying lesion. OBJECTIVE To compare the mean optic nerve sheath diameter (ONSD) measured using ultrasonography (USG) in patients with idiopathic intracranial hypertension (IIH) and normal healthy individuals. METHODS A prospective study. Ninety-seven participants aged 18-80 years were divided into two groups as patients with IIH (n=47) and the control group (n=50). The ONSD was measured using ultrasound with a 10-MHz probe. ONSD was measured 3 mm behind the optic disc. Receiver operating characteristic (ROC) curve analysis was performed to determine patients with IIH using ONSD. RESULTS Body mass index was higher in the IIH group compared with the control group (p=0.001). The mean ONSD was statistically significantly thicker in the IIH group (6.4 mm) than in the control group (4.90 mm). The cut-off value of ONSD in patients with IIH was measured as 5.70 mm. There was a significant negative correlation between ONSD and age (r:-0.416 and p<0.001). There was a positive correlation between BMI and ONSD (r: 0.437 and p<0.001). CONCLUSIONS Ultrasound can be a reliable, non-invasive and rapid tool to measure ONSD in monitoring patients with IIH. After the first diagnosis of IIH, based on neuroimaging and measuring intracranial pressure using invasive methods, ONSD can be used in treatment and follow-up.
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Affiliation(s)
- Kenan Dağdelen
- Beytepe Murat Erdi Eker State Hospital, Department of Ophthalmology, Çankaya, Ankara, Turkey
| | - Merve Ekici
- Beytepe Murat Erdi Eker State Hospital, Department of Neurology, Çankaya, Ankara, Turkey
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