Piergiorgio Lochner1, Marek Czosnyka2, Andrea Naldi3, Epameinondas Lyros4, Paolo Pelosi5,6, Shrey Mathur4, Klaus Fassbender4, Chiara Robba5. 1. Department of Neurology, Saarland University Medical Center, Homburg, Germany. piergiorgio.lochner@uks.eu. 2. Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK. 3. Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy. 4. Department of Neurology, Saarland University Medical Center, Homburg, Germany. 5. Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy. 6. Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
Abstract
BACKGROUND: Estimation of intracranial pressure (ICP) may be helpful in the management of neurological critically ill patients. It has been shown that ultrasonography of the optic nerve sheath diameter (ONSD) is a reliable tool for non-invasive estimation of increased intracranial pressure (ICP) at hospital admission or in intensive care. Less is known about the estimation of increased ICP and usefulness of ONSD in the prehospital setting. The aim of this review was to elucidate both prevailing and novel applications of ONSD for neurologists and critical care physicians. METHODS: In this review, we discuss the technique and the novel approach of ONSD measurement, the clinical applications of ONSD in neurology and critical care patients. RESULTS: ONSD measurement is simple, easy to learn, and has diverse applications. ONSD has utility for ICP measurement in intracranial hemorrhage and ischemic stroke, meningitis and encephalitis, and idiopathic intracranial hypertension (IIH). It is also valuable for lesser known syndromes, where an increase of ICP is postulated, such as acute mountain sickness and posterior reversible encephalopathy syndrome. ONSD changes develop in inflammatory or ischemic optic neuropathies. Some papers demonstrate the usefulness of ONSD studies in symptomatic intracranial hypotension. CONCLUSIONS: ONSD is a safe and low-cost bedside tool with the potential of screening patients who need other neuroimaging and those who may need an invasive measurement of ICP.
BACKGROUND: Estimation of intracranial pressure (ICP) may be helpful in the management of neurological critically illpatients. It has been shown that ultrasonography of the optic nerve sheath diameter (ONSD) is a reliable tool for non-invasive estimation of increased intracranial pressure (ICP) at hospital admission or in intensive care. Less is known about the estimation of increased ICP and usefulness of ONSD in the prehospital setting. The aim of this review was to elucidate both prevailing and novel applications of ONSD for neurologists and critical care physicians. METHODS: In this review, we discuss the technique and the novel approach of ONSD measurement, the clinical applications of ONSD in neurology and critical care patients. RESULTS: ONSD measurement is simple, easy to learn, and has diverse applications. ONSD has utility for ICP measurement in intracranial hemorrhage and ischemic stroke, meningitis and encephalitis, and idiopathic intracranial hypertension (IIH). It is also valuable for lesser known syndromes, where an increase of ICP is postulated, such as acute mountain sickness and posterior reversible encephalopathy syndrome. ONSD changes develop in inflammatory or ischemic optic neuropathies. Some papers demonstrate the usefulness of ONSD studies in symptomatic intracranial hypotension. CONCLUSIONS: ONSD is a safe and low-cost bedside tool with the potential of screening patients who need other neuroimaging and those who may need an invasive measurement of ICP.
Authors: Vincenzo Ficarra; Giacomo Novara; Walter Artibani; Andrea Cestari; Antonio Galfano; Markus Graefen; Giorgio Guazzoni; Bertrand Guillonneau; Mani Menon; Francesco Montorsi; Vipul Patel; Jens Rassweiler; Hendrik Van Poppel Journal: Eur Urol Date: 2009-01-25 Impact factor: 20.096
Authors: Thomas Geeraerts; Sybille Merceron; Dan Benhamou; Bernard Vigué; Jacques Duranteau Journal: Intensive Care Med Date: 2008-05-29 Impact factor: 17.440