The Contribution of Measuring the Optic Nerve Sheath Diameter by using Ultrasonography to the Diagnosis and Monitoring of Intracranial Hypertension

Öz

Background: Intracranial hypertension, which may have a number of different causes, is a medical emergency. Although difficult to identify due to non-specific symptoms, it must be treated appropriately. An early sign of intracranial hypertension is an increase is observed in the optic nerve sheath diameter. . Ultrasonography is a rapid and easy-to-apply method to detect an increase in optic nerve sheath diameter, and may be useful for the emergency diagnosis and treatment, as well as contributing to clinical follow-up. 

Case Presentation: In the present study, seven patients with clinical suspicion for rapid intracranial pressure were admitted. Clinical scenarios included traffic accident, metabolic imbalance, infection, and intracranial mass.  The pediatric emergency specialist performed optic nerve sheath measurement by using ultrasonography and a dilatation was detected. All measurements were taken by the certified and experienced pediatric emergency specialist blinded to the patient's clinical state and also the specialist was under observation of a lecturer during the measurements. Except for one patient, the control optic sheath diameter measurements were performed in the period, when they had no complaint, and the values were determined to be normal. To our knowledge, this case series is the first one examined in Turkey. The data from cases was collected between 2015 and 2016.

Conclusion: Optic nerve sheath diameter measurement is a non-invasive method that offers ease of diagnosis and follow-up of suspected intracranial hypertension.  

Anahtar Kelimeler

• Optic nerve sheath diameter measurement,intracranial hypertension

Kaynakça

1. 1. Del Saz-Saucedo P, Redondo-González O, Mateu-Mateu Á, Huertas-Arroyo R, García-Ruiz R, Botia-Paniagua E. Sonographic assessment of the optic nerve sheath diameter in the diagnosis of idiopathic intracranial hypertension. J Neurol Sci. 2016; 361:122-127.
2. 2. Marin JR, Lewiss RE. Point-of-Care ultrasonography by pediatric emergency medicine physicians. Pediatrics. 2015; 135(4): 1113-22.
3. 3. Marchese RF, Mistry RD, Scarfone RJ, Chen AE. Identification of optic disc elevation and the crescent sign using point-of-care oculer ultrasound in children. Pediatr Emerg Care. 2015; 31(4): 304-7.
4. 4. Amin D, McCormick T, Mailhot T. Elevated intracranial pressure diagnosis with emergency department bedside ocular ultrasound. Case Rep Emerg Med. 2015; 385970: 3p.
5. 5. Zaidi SJH, Yamamoto LG. Optic nerve sheath diameter measurements by CT scan in ventriculoperitoneal shunt obstruction. Hawaii J Med Public Health. 2014; 73(8): 251-5.
6. 6. Qayyum H, Ramlakhan S. Can oculer ultrasound predict intracranial hypertension? A pilot diagnostic accuracy evaluation in a UK emergency department. Eur J of Emerg Med. 2013; 20(2):91-97.
7. 7. Maude RR, Hossain A, Hassan MU, Osbourne S, Sayeed KLA, et al. Transorbital sonographic evaluation of normal optic nerve sheath diameter in healthy volunteers in Bangladesh. PLoS One. 2013; 8(12): e81013.
8. 8. McLario DJ, Sivitz AB. Point of care ultrasound in pediatric clinical care. JAMA Pediatr. 2015;169(6):594-600.

9. 9. Yakov MB, Desjardins MP, Fischer JWJ. Emergency point-of-care ultrasound detection of papilledema in the pediatric emergency department. Pediatr Emerg Care. 2015; 31(11): 766-70.
10. 10. Stone MB. Ultrasound diagnosis of papilledema and increased intracranial pressure in pseudotumor cerebri. Am J Emerg Med. 2009; 27(3): 376.e1–376.e2.
11. 11. Lochner P, Nardone R, Tezzon F, Coppo L, Brigo F. Optic nerve sonography to monitor treatment efficacy in idiopathic intracranial hypertension: A Case Report. J Neuroimaging. 2013; 23: 533-534.
12. 12. Salahuddin N, Mohammed A, Alharbi N, Ansari H, Zaza KJ, Marashly Q et al. The incidence of increased ICP in ICU patients with non-traumatic coma as diagnosed by ONSD and CT: a prospective cohort study. BMC Anesthesiology. 2016; 16(1):106.
13. 13. Irazuzta JE, Brown ME, Akhtar J. Bedside optic nerve sheath diameter assessment in the identification of increased ıntracranial pressure in suspected idiopathic intracranial hypertension. Pediatr Neurol. 2016; 54: 35-38.
14. 14. Marchese RF, Mistry R, Binenbaum G, Liu GT, Scarfone RJ, Woodford AL et al. Identification of optic nerve swelling using point-of-care ocular ultrasound in children. Pediatr Emerg Care. 2018; 34(8): 531-536.
15. 15. Padayachly LC, Padayachly V, Galal U, Gray R, Fieggen AG. The relationship between transorbital ultrasound measurement of the optic nerve sheath diameter (ONSD) and invasively measured ICP in children. Childs Nerv Syst. 2016; 32:1769–1778.