#VisualAbstract: Bedside Optic Nerve Ultrasonography for Diagnosing Increased Intracranial Pressure

1. Optic nerve sheath dilation, defined as greater than 5.0mm on ultrasound, had a high specificity for indicating elevated intracranial pressure, while less than 5.0mm had a high sensitivity to help rule out elevated intracranial pressures.

2. Patients presenting with a suspected traumatic brain injury and a positive ultrasound result had 6.9 times the odds of having elevated intracranial pressures.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Intracranial pressure can be diagnosed in several ways such as magnetic resonance imaging, computed tomography and lumbar puncture. Optic nerve ultrasonography has been increasingly used as a noninvasive, quick and easy technique to diagnose increased intracranial pressure A linear array transducer can be applied to a closed eyelid in the coronal plane of a supine patient to measure the optic nerve sheath diameter. This systematic review and meta-analysis evaluated the accuracy and optimal cutoff values of diagnostic optic nerve ultrasonography to detect increased intracranial pressures. Optic nerve ultrasonography had a 97% sensitivity and 86% specificity in detecting increased intracranial pressures in patients with traumatic brain injuries. In patients with non-traumatic brain injuries, ultrasound detection had a 92% sensitivity and 86% specificity. 5.0mm was the optimal cutoff for optic nerve sheath dilation to detect elevated intracranial pressures. Due to the small study sizes and possible publication biases, more research needs to be done on the use of optic nerve ultrasound and its effects on clinical outcomes. Other current means of detecting elevated intracranial pressure – including CT, MRI, lumbar puncture, and intracranial pressure monitoring – are more expensive, time consuming, and invasive. Optic nerve ultrasonography would allow for a faster, cheaper, and less invasive means to detect increased intracranial pressures leading to early diagnosis, prompt intervention, and better outcomes for patients.

Click to read the study in Annals of Internal Medicine