The diagnostic performance of ultrasonographic optic nerve sheath diameter and color Doppler indices of the ophthalmic arteries in detecting elevated intracranial pressure
Introduction
Detecting a clinically significant elevation in the intracranial pressure (ICP) is a pivotal step in triage of patients with neurosurgical conditions [1]. At the moment, computed tomography (CT) is considered as the noninvasive method of choice in this regard, but important disadvantages such as the need for patient transportation, being time-consuming and excessive radiation hazards have urged researchers to find other alternatives [2].
In the last decade ultrasonographic techniques including determination of the optic nerve sheath diameter (ONSD) [3], [4], [5] and transcranial Doppler (TCD) examination [6], [7], [8], [9] have been tried to safely detect episodes of increased ICP. Siaudvytyte et al. [8] suggested the ophthalmic arteries as natural ICP sensors and even a TCD-based technique has been devised to use these arteries to estimate intracranial pressure [9]. Technical shortcomings such as inability of ultrasound waves to adequately penetrate the skull [10], [11] and anatomical variations in the transcranial portion of the ophthalmic arteries [12], [13], however, have rendered TCD inaccurate in revealing intracranial hypertension [8], [14], [15]. To obviate these limitations, we hypothesized that Doppler ultrasound waveform indices of the ophthalmic arteries could be used instead of a TCD approach. So, the present study sought to examine this hypothesis in a group of patients with CT findings suggestive of a clinically significant increase in the ICP and a control group including healthy counterparts. At the same time, the accuracy of ultrasonographic ONSD in detecting intracranial hypertension was tested.
Section snippets
Study design and participants
A cohort of 60 subjects including patients with acute clinical and radiological signs of an elevated ICP (cases, n = 30) and subjects with normal ICPs (controls, n = 30) were prospectively recruited from a teaching hospital between May 2014 and March 2015. Obvious ophthalmic injuries or eye pathologies were the exclusion criteria. Before enrollment, informed written consents were obtained from participants. This work was carried out in accordance with the Code of Ethics of the World Medical
Results
The case group comprised 22 males (73.3%) and 8 females (26.8%) with a mean age of 48.40 ± 18.97 years (range, 22–82). In this group the mean Glasgow Coma Scale (GCS) was 8.83 ± 1.53 at the time of admission; and the mean time between the development of symptoms and ONSD measurement was 4.33 ± 1.09 days (range, 3–7). The controls were 15 males (50%) and 15 females (50%) with a mean age of 44.00 ± 16.29 years (range, 18–80). Cases and controls were comparable for their sex (chi-square test, p = 0.06) and
Discussion
The optic nerve sheath is comprised of all three meningeal layers (dura, arachnoid, and pia mater) [16]. In case of a raised ICP the optic nerve diameter increases initially and then papilloedema ensues. So, transorbital ultrasonography could detect an increased ICP earlier than ophthalmoscopy [17]. For the first time in 1968, Hayreh demonstrated a dynamic communication between the intracranial cavity and the subarachnoid space encasing the optic nerve [18]. Twenty-nine years later, Hansen and
Conclusion
While ultrasonographic ONSD was fully accurate in detecting acute elevated ICPs, color Doppler ultrasound examination of the ophthalmic arteries was insufficiently accurate in this regard.
Conflicts of interest
None.
Financial support
None.
Acknowledgment
This study was not supported by any external sources.
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