Top

Published in:

Open Access 01-06-2008 | Research

Optic nerve sonography in the diagnostic evaluation of adult brain injury

Authors: Theodoros Soldatos, Dimitrios Karakitsos, Katerina Chatzimichail, Matilda Papathanasiou, Athanasios Gouliamos, Andreas Karabinis

Published in: Critical Care | Issue 3/2008

Abstract

Introduction

The optic nerve sheath diameter (ONSD) may be increased in brain-injured patients, especially children, with intracranial hypertension. We investigated whether measurements of ONSD correlated with simultaneous noninvasive and invasive measurements of the intracranial pressure (ICP) in brain-injured adults.

Methods

Seventy-six critical care patients (58 males; 47 ± 18 years old) were included in the study. Fifty patients suffered from brain injury, whereas 26 had no intracranial pathology and served as control individuals. Initially, brain-injured patients were evaluated clinically (Glasgow Coma Scale) and using a semiquantitative (I to VI) neuroimaging scale (Marshall Scale). Thereafter, the patients were divided into those with moderate (Marshall Scale = I and Glasgow Coma Scale > 8 [n = 18]) and severe (Marshall Scale = II to VI and Glasgow Coma Scale ≤8 [n = 32]) brain injury. All patients underwent noninvasive measurement of the ICP (estimated ICP) by transcranial Doppler sonography, and synchronous ONSD measurements by optic nerve sonography. Finally, invasive ICP measurement using an intraparenchymal catheter was performed in patients with severe brain injury.

Results

ONSD and estimated ICP were both significantly increased (6.1 ± 0.7 mm and 26.2 ± 8.7 mmHg, respectively; P < 0.0001) in patients with severe brain injury as compared with patients with moderate brain injury (4.2 ± 1.2 mm and 12.0 ± 3.6 mmHg) and compared with control individuals (3.6 ± 0.6 mm and 10.3 ± 3.1 mmHg). Furthermore, in patients with severe brain injury the ONSD measurements were strongly correlated with estimated ICP values (r = 0.80, P < 0.0001) as well as with the neuroimaging scale results (r = 0.82, P < 0.001). In the patients with severe brain injury, ONSD measurements correlated with invasive ICP values (r = 0.68, P = 0.002). The best cut-off value of ONSD for predicting elevated ICP was 5.7 mm (sensitivity = 74.1% and specificity = 100%).

Conclusion

ONSD measurements correlate with noninvasive and invasive measurements of the ICP, and with head computed tomography scan findings in brain-injured adults. Hence, optic nerve sonography may serve as an additional diagnostic tool that could alert clinicians to the presence of elevated ICP, whenever invasive ICP evaluation is contraindicated and/or is not available. This trial is International Standard Randomised Controlled Trial Number registered (ISRCTN 91941687).

Available only for authorised users

Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M: Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med 2007, 49: 508-514. 10.1016/j.annemergmed.2006.06.040CrossRefPubMed

Czosnyka M, Matta BF, Smielewski P, Kirkpatrick PJ, Pickard JD: Cerebral perfusion pressure in head-injured patients: a noninvasive assessment using transcranial Doppler ultrasonography. J Neurosurg 1998, 88: 802-808.CrossRefPubMed

Czosnyka M, Pickard JD: Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry 2004, 75: 813-821. 10.1136/jnnp.2003.033126PubMedCentralCrossRefPubMed

Tsung JW, Blaivas M, Cooper A, Levick NR: A rapid noninvasive method of detecting elevated intracranial pressure using bedside ocular ultrasound: application to 3 cases of head trauma in the pediatric emergency department. Pediatr Emerg Care 2005, 21: 94-98. 10.1097/01.pec.0000159052.64930.64CrossRefPubMed

Seestedt RC, Frankel MR: Intracerebral hemorrhage. Curr Treat Options Neurol 1999, 1: 127-137. 10.1007/s11940-999-0012-xCrossRefPubMed

Lee LA, Sharar SR, Lam AM: Perioperative head injury management in the multiply injured trauma patient. Int Anesthesiol Clin 2002, 40: 31-52. 10.1097/00004311-200204000-00005CrossRefPubMed

Malayeri AA, Bavarian S, Mehdizadeh M: Sonographic evaluation of optic nerve diameter in children with raised intracranial pressure. J Ultrasound Med 2005, 24: 143-147.PubMed

Helmke H, Hansen HC: Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. II. Patient study. Pediatr Radiol 1996, 26: 706-710. 10.1007/BF01383384CrossRefPubMed

Bellner J, Romner B, Reinstrup P, Kristiansson KA, Ryding E, Brandt L: Transcranial Doppler sonography pulsatility index (PI) reflects intracranial pressure (ICP). Surg Neurol 2004, 62: 45-51. 10.1016/j.surneu.2003.12.007CrossRefPubMed

10.

Voulgaris SG, Partheni M, Kaliora H, Haftouras N, Pessach IS, Polyzoidis KS: Early cerebral monitoring using the transcranial Doppler pulsatility index in patients with severe brain trauma. Med Sci Monit 2005, 11: 49-52.

11.

Splavski B, Radanović B, Muzević D, Has B, Janculjak D, Kristek J, Jukić D: Assessment of intra-cranial pressure after severe traumatic brain injury by transcranial Doppler ultrasonography. Brain Inj 2006, 20: 1265-1270. 10.1080/02699050601082099CrossRefPubMed

12.

Schmidt B, Czosnyka M, Klingelhöfer J: Clinical applications of a non-invasive ICP monitoring method. Eur J Ultrasound 2002, 16: 37-45. 10.1016/S0929-8266(02)00044-7CrossRefPubMed

13.

Homburg AM, Jakobsen M, Enevoldsen E: Transcranial Doppler recordings in raised intracranial pressure. Acta Neurol Scand 1993, 87: 488-493.CrossRefPubMed

14.

Chan KH, Miller JD, Dearden NM, Andrews PJ, Midgley SL: The effect of changes in cerebral perfusion pressure upon middle cerebral artery blood flow velocity and jugular bulb venous oxygen saturation after severe brain injury. J Neurosurg 1992, 77: 55-61.CrossRefPubMed

15.

Klingelhöfer J, Conrad B, Benecke R, Sander D, Markakis E: Evaluation of intracranial pressure from transcranial Doppler studies in cerebral disease. J Neurol 1988, 235: 159-162. 10.1007/BF00314307CrossRefPubMed

16.

Schmidt B, Czosnyka M, Raabe A, Yahya H, Schwarze JJ, Sackerer D, Sander D, Klingelhöfer J: Adaptive noninvasive assessment of intracranial pressure and cerebral autoregulation. Stroke 2003, 34: 84-89. 10.1161/01.STR.0000047849.01376.AECrossRefPubMed

17.

Hassler W, Steinmetz H, Gawlowski J: Transcranial Doppler ultrasonography in raised intracranial pressure and in intracranial circulatory arrest. J Neurosurg 1988, 68: 745-751.PubMed

18.

Aaslid R, Huber P, Nornes H: A transcranial Doppler method in the evaluation of cerebrovascular spasm. Neuroradiology 1986, 28: 11-16. 10.1007/BF00341759CrossRefPubMed

19.

Karakitsos D, Soldatos T, Gouliamos A, Armaganidis A, Poularas J, Kalogeromitros A, Boletis J, Kostakis A, Karabinis A: Transorbital sonographic monitoring of optic nerve diameter in patients with severe brain injury. Transplant Proc 2006, 38: 3700-3706. 10.1016/j.transproceed.2006.10.185CrossRefPubMed

20.

Newman WD, Hollman AS, Dutton GN, Carachi R: Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus. Br J Opthalmol 2002, 86: 1109-1113. 10.1136/bjo.86.10.1109CrossRef

21.

Geeraerts T, Launey Y, Martin L, Pottecher J, Vigué B, Duranteau J, Benhamou D: Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med 2007, 33: 1704-1711. 10.1007/s00134-007-0797-6CrossRefPubMed

22.

Gangemi M, Cennamo G, Maiuri F, D'Andrea F: Echographic measurement of the optic nerve in patients with intracranial hypertension. Neurochirurgia (Stuttg) 1987, 30: 53-55.

23.

Brzezinska R, Schumacher R: Diagnosis of elevated intracranial pressure in children with shunt under special consideration of transglobe sonography of the optic nerve. Ultraschall Med 2002, 23: 325-332. 10.1055/s-2002-35050CrossRefPubMed

24.

Blaivas M, Theodoro D, Sierzenski PR: Elevated intracranial pressure detected by bedside emergency ultrasonography of optic nerve sheath. Acad Emerg Med 2005, 45: 336-337. 10.1016/j.annemergmed.2004.09.031

25.

Galetta S, Byrne SF, Smith JL: Echographic correlation of optic nerve sheath size and cerebrospinal fluid pressure. J Clin Neuroopthalmol 1989, 9: 79-82.

26.

Helmke K, Burdelski M, Hansen HC: Detection and monitoring of intracranial pressure dysregulation in liver failure by ultrasound. Transplantation 2000, 27: 392-395. 10.1097/00007890-200007270-00029CrossRef

27.

Girisgin AS, Kalkan E, Kocak S, Cander B, Gul M, Seniz M: The role of optic nerve ultrasonography in the diagnosis of elevated intracranial pressure. Emerg Med J 2007, 24: 251-254. 10.1136/emj.2006.040931PubMedCentralCrossRefPubMed

28.

Marshall LF, Marshall SB, Klauber MR, Van Berkum Clark M, Eisenberg H, Jane JA, Luerssen TG, Marmarou A, Foulkes MA: The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma 1992, (Suppl 1):287-292.

29.

Hansen HC, Helmke K: Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests. J Neurosurg 1997, 87: 34-40.CrossRefPubMed

30.

Bland JM, Altman DG: Correlation, regression, and repeated data. BMJ 1994, 308: 896.PubMedCentralCrossRefPubMed

31.

Kirkpatrick PJ, Chan KH: Transcranial Doppler. In Head injury. Edited by: Reilly P, Bullock R. London, UK: Chapman and Hall; 1997:243-259.

32.

Gupta AK: Monitoring the injured brain in the intensive care unit. J Postgrad Med 2002, 48: 218-225.PubMed

33.

Bhatia A, Gupta AK: Neuromonitoring in the intensive care unit. I. Intracranial pressure and cerebral blood flow monitoring. Intensive Care Med 2007, 33: 1263-1271. 10.1007/s00134-007-0678-zCrossRefPubMed

34.

Romagnuolo L, Tayal V, Tomaszewski C, Saunders T, Norton HJ: Optic nerve sheath diameter does not change with patient position. Am J Emerg Med 2005, 23: 686-688. 10.1016/j.ajem.2004.11.004CrossRefPubMed

35.

Ballantyne SA, O'Neill G, Hamilton R, Hollman AS: Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults. Eur J Ultrasound 2002, 15: 145-149. 10.1016/S0929-8266(02)00036-8CrossRefPubMed

36.

Helmke H, Hansen HC: Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. Experimental study. Pediatr Radiol 1996, 26: 701-705. 10.1007/BF01383383CrossRefPubMed

37.

Beatty S, Good PA, McLaughlin J, O'Neill EC: Echographic measurements of the retrobulbar optic nerve in normal and glaucomatous eyes. Br J Opthalmol 1998, 82: 43-47.CrossRef

38.

Rothman MI, Zoarski GH: The orbit. In Textbook of Radiology and Imaging. Volume 2. 7th edition. Edited by: Sutton D. London, UK: Churchill Livingstone; 2003:1573-1595.

39.

Holt GR, Holt JE: Incidence of eye injuries in facial fractures: an analysis of 727 cases. Otolaryngol Head Neck Surg 1983, 91: 276-279.PubMed

Title: Optic nerve sonography in the diagnostic evaluation of adult brain injury
Authors: Theodoros Soldatos
Dimitrios Karakitsos
Katerina Chatzimichail
Matilda Papathanasiou
Athanasios Gouliamos
Andreas Karabinis
Publication date: 01-06-2008
Publisher: BioMed Central
Published in: Critical Care / Issue 3/2008
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc6897

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Optic nerve sonography in the diagnostic evaluation of adult brain injury

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 3/2008

The role of corticosteroids in severe community-acquired pneumonia: a systematic review

Quantification of lean and fat tissue repletion following critical illness: a case report

Ventilator-associated tracheobronchitis (VAT): questions, answers, and a new paradigm?

How best to recruit the injured lung?

Probiotics in the intensive care unit: why controversies and confusion abound

Surviving sepsis: a guide to the guidelines