Optic nerve sheath diameters in nontraumatic brain injury: A scoping review and role in the intensive care unit

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.

Keywords: Intracranial hypertension; Intracranial pressure monitoring; Medical intensive care unit; Neuro-monitoring; Non-traumatic brain injury; Optic nerve sheath diameter; Optic nerve ultrasound.

Figure 1

Scheme for data extraction.