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. 2014 Nov;18(11):728-34.
doi: 10.4103/0972-5229.144015.

Optic nerve sheath diameter as a marker for evaluation and prognostication of intracranial pressure in Indian patients: An observational study

Chetan G Shirodkar  1 , S Manimala Rao  1 , Dnyaneshwar P Mutkule  1 , Yogesh R Harde  1 , Pradeep M Venkategowda  1 , M Uma Mahesh  1
Affiliations

Optic nerve sheath diameter as a marker for evaluation and prognostication of intracranial pressure in Indian patients: An observational study

Chetan G Shirodkar et al. Indian J Crit Care Med. 2014 Nov.

Abstract

Background and aims: The aim was to evaluate efficacy of optic nerve sheath diameter (ONSD) by ultrasound as a noninvasive method for detecting raised intracranial pressure (ICP) in intensive care unit, to compare with computed tomography/magnetic resonance imaging (MRI) findings of raised ICP and to prognosticate ONSD value with treatment.

Materials and methods: We conducted a prospective, observational study on 101 adults by including 41 healthy individuals in group A as control and 60 patients in group B admitted with fever, headache, vomiting, and altered sensorium. We examined them in supine position using 10 MHz linear array probe on closed eyelid. ONSD was measured 3 mm behind the globe in each eye. A mean binocular ONSD > 4.6 mm in female and 4.8 mm in male was considered abnormal. Midline shift, edema, effacement or ONSD > 5.0 mm on T2 MRI suggestive of elevated ICP was used to evaluate ONSD accuracy.

Results: Group A mean ONSD was 4.6 mm in females and 4.8 mm in males. Group B mean ONSD for 17 females was 5.103 ± 0.6221 mm (P = 0.002) and for 43 males 5.081 ± 0.5799 mm (P = 0.032). Radiological sign of raised ICP was confirmed in 35 patients (females = 11 and males = 24) with high ONSD value. Sensitivity of detecting raised ICP by ONSD was 84.6% in females and 75% in males while specificity was 100% in both genders. Out of 25 patients without radiological signs of raised ICP 10 patients showed high ONSD (females = 4.735 mm and males = 4.907 mm). ONSD was well prognosticated with treatment modalities.

Conclusion: Bedside ocular ultrasonography for measuring ONSD can be used an early test for diagnosing raised ICP as it is a noninvasive, cost effective bedside test, which can be repeated for re-evaluation.

Keywords: Computed tomography; intensive care unit; magnetic resonance imaging; mannitol; optic nerve sheath diameter; raised intracranial pressure; ultrasonography.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Occular sonography: High frequency 10 MHz linear array probe placed on the gel on the closed eyelid
Figure 2
Figure 2
The optic nerve sheath diameter (ONSD) measurement: Optic nerve appears homogeneous with low internal reflectivity compared with the high reflectivity of the nerve sheath. ONSD measured 3 mm behind the globe using an electronic caliper with an angle perpendicular to the eye ball
Figure 3
Figure 3
Receiving operating characteristic curve for detecting raised intracranial pressure by ultrasonography optic nerve sheath diameter for female
Figure 4
Figure 4
Receiving operating characteristic curve for detecting raised intracranial pressure by ultrasonography optic nerve sheath diameter for male
See this image and copyright information in PMC

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