Log in | Register

Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury

Thomas Geeraerts| Yoann Launey| Laurent Martin| Julien Pottecher| Bernard Vigué| Jacques Duranteau| Dan Benhamou
Original
Volume 33, Issue 10 / October , 2007

Pages 1704 - 1711

Abstract

Objective

To assess at admission to the ICU the relationship between optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) and to investigate whether increased ONSD at patient admission is associated with raised ICP in the first 48 h after trauma.

Design and setting

Prospective, blind, observational study in a surgical critical care unit, level 1 trauma center.

Patients and participants

31 adult patients with severe traumatic brain injury (TBI; Glasgow coma scale ≤ 8) requiring sedation and ICP monitoring, and 31 control patients without brain injury requiring sedation.

Measurements and results

ONSD was measured with a 7.5-MHz linear ultrasound probe. Two TBI groups were defined on the basis of ICP profile. If ICP exceeded 20 mmHg for more than 30 min in the first 48 h (before any specific treatment), patients were considered to have high ICP; if not, they had normal ICP. The largest ONSD value (the highest value for the right and left eye) was significantly higher in high ICP patients (6.3 ± 0.6 vs. 5.1 ± 0.7 mm in normal ICP patients and 4.9 ± 0.3 mm in control patients). There was a significant relationship between the largest ONSD and ICP at admission (r = 0.68). The largest ONSD was a suitable predictor of high ICP (area under ROC curve 0.96). When ONSD was under 5.7 mm, the sensitivity and negative predictive values for high ICP were 100%.

Conclusions

In the early posttraumatic period, ocular ultrasound scans may be useful for detecting high ICP after severe TBI.

Keywords

References

  1. Becker DP, Miller JD, Ward JD, Greenberg RP, Young HF, Sakalas R (1977) The outcome from severe head injury with early diagnosis and intensive management. J Neurosurg 47:491–502
    • View reference on PubMed
  2. Marshall LF, Smith RW, Shapiro HM (1979) The outcome with aggressive treatment in severe head injuries. II. Acute and chronic barbiturate administration in the management of head injury. J Neurosurg 50:26–30
    • View reference on PubMed
  3. Chesnut RM, Marshall LF, Klauber MR, Blunt BA, Baldwin N, Eisenberg HM, Jane JA, Marmarou A, Foulkes MA (1993) The role of secondary brain injury in determining outcome from severe head injury. J Trauma 34:216–222
    • View reference on PubMed
  4. Ghajar J (2000) Traumatic brain injury. Lancet 356:923–929
    • View reference on PubMed
    • View reference on publisher's website
  5. Hassler W, Steinmetz H, Gawlowski J (1988) Transcranial Doppler ultrasonography in raised intracranial pressure and in intracranial circulatory arrest. J Neurosurg 68:745–751
    • View reference on PubMed
  6. Aaslid R, Huber P, Nornes H (1986) A transcranial Doppler method in the evaluation of cerebrovascular spasm. Neuroradiology 28:11–16
    • View reference on PubMed
    • View reference on publisher's website
  7. Kirkpatrick PJ, Chan KH (1997) Transcranial Doppler. In: Reilly P, Bullock R (eds) Head injury. Chapman & Hall, London
  8. Liu D, Kahn M (1993) Measurement and relationship of subarachnoid pressure of the optic nerve to intracranial pressures in fresh cadavers. Am J Ophthalmol 116:548–556
    • View reference on PubMed
  9. Villain MA, Candon E, Arnaud B, Hamard H, Adenis JP (2003) Optic nerve sheath decompression in optic neuropathy complicating idiopathic intracranial hypertension: a new focus. J Fr Ophtalmol 26:191–197
    • View reference on PubMed
  10. Hayreh SS (1968) Pathogenesis of oedema of the optic disc. Doc Ophthalmol 24:289–411
    • View reference on PubMed
    • View reference on publisher's website
  11. Lichtenstein D (1992) In: Lichtenstein D (eds) L'echographie générale en réanimation. Springer, Berlin Heidelberg New York
  12. Hansen HC, Helmke K (1996) The subarachnoid space surrounding the optic nerves. An ultrasound study of the optic nerve sheath. Surg Radiol Anat 18:323–328
    • View reference on PubMed
    • View reference on publisher's website
  13. Hansen HC, Helmke K (1997) Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests. J Neurosurg 87:34–40
    • View reference on PubMed
  14. Newman WD, Hollman AS, Dutton GN, Carachi R (2002) Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus. Br J Ophthalmol 86:1109–1113
    • View reference on PubMed
    • View reference on publisher's website
  15. Blaivas M, Theodoro D, Sierzenski PR (2003) Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med 10:376–381
    • View reference on PubMed
    • View reference on publisher's website
  16. Helmke K, Burdelski M, Hansen HC (2000) Detection and monitoring of intracranial pressure dysregulation in liver failure by ultrasound. Transplantation 70:392–395
    • View reference on PubMed
    • View reference on publisher's website
  17. Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M (2007) Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med 49:508–514
    • View reference on PubMed
    • View reference on publisher's website
  18. Helmke K, Hansen HC (1996) Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. I. Experimental study. Pediatr Radiol 26:701–705
    • View reference on PubMed
    • View reference on publisher's website
  19. Helmke K, Hansen HC (1996) Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension. II. Patient study. Pediatr Radiol 26:706–710
    • View reference on PubMed
    • View reference on publisher's website
  20. Blaivas M, Theodoro D, Sierzenski PR (2002) A study of bedside ocular ultrasonography in the emergency department. Acad Emerg Med 9:791–799
    • View reference on PubMed
    • View reference on publisher's website
  21. Steiner LA, Andrews PJ (2006) Monitoring the injured brain: ICP and CBF. Br J Anaesth 97:26–38
    • View reference on PubMed
    • View reference on publisher's website
  22. Jaffres P, Brun J, Declety P, Bosson JL, Fauvage B, Schleiermacher A, Kaddour A, Anglade D, Jacquot C, Payen JF (2005) Transcranial Doppler to detect on admission patients at risk for neurological deterioration following mild and moderate brain trauma. Intensive Care Med 31:785–790
  23. Ract C, Le Moigno S, Bruder N, Vigue B (2007) Transcranial Doppler ultrasound goal-directed therapy for the early management of severe traumatic brain injury. Intensive Care Med 33:645–651
  24. Barnett SB, Ter Haar GR, Ziskin MC, Rott HD, Duck FA, Maeda K (2000) International recommendations and guidelines for the safe use of diagnostic ultrasound in medicine. Ultrasound Med Biol 26:355–366
    • View reference on PubMed
    • View reference on publisher's website
  25. Marshall LF, Marshall SB, Klauber MR, Van Berkum Clark M, Eisenberg H, Jane JA, Luerssen TG, Marmarou A, Foulkes MA (1992) The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma [Suppl] 9(1):S287–S292
  26. Eisenberg HM, Gary HE Jr, Aldrich EF, Saydjari C, Turner B, Foulkes MA, Jane JA, Marmarou A, Marshall LF, Young HF (1990) Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg 73:688–698
    • View reference on PubMed
  27. Lobato RD, Sarabia R, Rivas JJ, Cordobes F, Castro S, Munoz MJ, Cabrera A, Barcena A, Lamas E (1986) Normal computerized tomography scans in severe head injury. Prognostic and clinical management implications. J Neurosurg 65:784–789
    • View reference on PubMed
  28. Stein SC, Spettell C, Young G, Ross SE (1993) Delayed and progressive brain injury in closed-head trauma: radiological demonstration. Neurosurgery 32:25–30
    • View reference on PubMed
    • View reference on publisher's website
  29. Holt GR, Holt JE (1983) Incidence of eye injuries in facial fractures: an analysis of 727 cases. Otolaryngol Head Neck Surg 91:276–279
    • View reference on PubMed
  30. Williamson TH, Harris A (1996) Color Doppler ultrasound imaging of the eye and orbit. Surv Ophthalmol 40:255–267
    • View reference on PubMed
    • View reference on publisher's website
  31. Ballantyne SA, O'Neill G, Hamilton R, Hollman AS (2002) Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults. Eur J Ultrasound 15:145–149
    • View reference on PubMed
    • View reference on publisher's website
  32. Cremer OL, van Dijk GW, van Wensen E, Brekelmans GJ, Moons KG, Leenen LP, Kalkman CJ (2005) Effect of intracranial pressure monitoring and targeted intensive care on functional outcome after severe head injury. Crit Care Med 33:2207–2213
    • View reference on PubMed
    • View reference on publisher's website
  33. Brain Trauma Foundation, American Association of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care (2000) Recommendations for intracranial pressure monitoring technology. J Neurotrauma 17:497–506

Sign In

Connect with ICM

Top 5 Articles Editors Picks Supplement