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Patil MM, Joshi DS, Abbadi AG, Shethe CB. Optic nerve sheath diameter as a noninvasive adjunct tool in the evaluation of intracranial pressure. BMJ Case Rep 2024; 17:e259543. [PMID: 38604741 PMCID: PMC11015262 DOI: 10.1136/bcr-2023-259543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024] Open
Affiliation(s)
| | - Deepti S Joshi
- Ophthalmology, MM Joshi Eye Institute, Hubli, Karnataka, India
| | | | - Cauvery B Shethe
- Ophthalmology, Anugraha Hospital, Vijayapura, Vijayapura, Karnataka, India
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2
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Leung HS, Choi CHJ, Lau EHL, Wong WYE, Cheung CY, Chan YYA. Eagle jugular syndrome presenting with intracranial hypertension - Diagnosis and illustration of pathophysiology by multi-modality imaging. Neuroradiol J 2024; 37:251-256. [PMID: 37385015 PMCID: PMC10973833 DOI: 10.1177/19714009231187347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Eagle jugular syndrome is an uncommon condition caused by compression of an elongated styloid process onto the internal jugular vein. Its presentation is non-specific but may represent in severe clinical consequences including venous thrombosis and intracranial haemorrhage. Thorough understanding of local anatomy is important in understanding the pathogenesis and establishing the diagnosis. Our case reported here illustrates the use of multimodality imaging, including dynamic Computer tomography manoeuvre, in identifying the site of obstruction and guidance towards successful surgical treatment.
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Affiliation(s)
- Ho Sang Leung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Chun Ho Joseph Choi
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Eric Hui Lun Lau
- Department of Otorhinolaryngology, Head & Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Wai Yeung Eddy Wong
- Department of Otorhinolaryngology, Head & Neck Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Chi Yan Cheung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Yin Yan Anne Chan
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Okpara SE, Uche EO, Iloanusi NI, Iloabachie IC, Mezue WC, Onyia EE, Chikani MC, Mathew M. Correlation of the transorbital ultrasonographic optic nerve sheath diameter with intracranial pressure measured intraoperatively in infants with hydrocephalus. J Neurosurg Pediatr 2024; 33:334-342. [PMID: 38215445 DOI: 10.3171/2023.12.peds23273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/13/2023] [Indexed: 01/14/2024]
Abstract
OBJECTIVE Hydrocephalus is a highly significant global public health concern. In infants, it may be associated with a potentially deleterious increase in intracranial pressure (ICP). Currently, the gold standard for accurate monitoring of ICP is an intraventricular ICP monitor, but this method is invasive and expensive. Transorbital ultrasound measurement of the optic nerve sheath diameter (ONSD) may provide a noninvasive and cost-effective alternative method for monitoring ICP. The goal of the study was to determine the extent of the correlation between ultrasonographic ONSD and ICP in infants. METHODS A prospective observational study of 47 children with hydrocephalus aged ≤ 18 months was performed. The ONSD was measured with a transorbital ultrasound scan, while the intraventricular CSF opening pressure was assessed using a manometer during ventriculoperitoneal shunt insertion. Data were analyzed using SPSS software. The ONSD and ICP measurements were correlated, the receiver operating characteristic (ROC) curve was evaluated, and a sensitivity analysis was performed. Inferences were made using the 0.05 alpha level of significance. RESULTS The mean age of the study cohort was 4.8 ± 4.3 months, and 93.6% of patients were infants. The mean ONSD was 4.5 ± 0.7 mm (range 2.9-6.0 mm), and the mean ICP was 19.9 ± 6.5 mm Hg (range 5.2-32.4 mm Hg). Both ONSD and ICP increased with increasing age. The Pearson correlation coefficient revealed a strong positive correlation between ONSD and ICP (r = 0.77, p < 0.001). The ONSD cutoff points were 3.2 mm, 4.0 mm, and 4.6 mm for patients with ICPs of 10 mm Hg, 15 mm Hg, and ≥ 20 mm Hg, respectively. The sensitivity of ONSD was 97.7% (area under the ROC curve 0.99), and for every 14.3-mm Hg increase in ICP, the ONSD increased by 1.0 mm holding age constant. CONCLUSIONS ONSD has a strong positive correlation with ICP. Correspondingly, ONSD is highly sensitive in estimating ICP.
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Affiliation(s)
- Samuel E Okpara
- 1Department of Surgery, Neurosurgery Division, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Enoch O Uche
- 1Department of Surgery, Neurosurgery Division, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Nneka I Iloanusi
- 2Department of Radiation Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria; and
| | - Izuchukwu C Iloabachie
- 1Department of Surgery, Neurosurgery Division, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Wilfred C Mezue
- 1Department of Surgery, Neurosurgery Division, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Ephraim E Onyia
- 1Department of Surgery, Neurosurgery Division, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Mark C Chikani
- 1Department of Surgery, Neurosurgery Division, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Mesi Mathew
- 3Department of Neurosurgery, Hull Royal Infirmary, Hull University Teaching Hospitals, Hull, United Kingdom
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Li CMF, MacDougall K, Fraser JA. Teaching NeuroImage: Transcalvarial Lymphoma: A Rare Cause of Secondary Intracranial Hypertension. Neurology 2024; 102:e209227. [PMID: 38354336 DOI: 10.1212/wnl.0000000000209227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/20/2023] [Indexed: 02/16/2024] Open
Affiliation(s)
- Cathy Meng Fei Li
- From the Department of Clinical Neurological Sciences (C.M.L., K.M., J.A.F.), and Department of Ophthalmology (J.A.F.), Western University, London, Ontario, Canada
| | - Keith MacDougall
- From the Department of Clinical Neurological Sciences (C.M.L., K.M., J.A.F.), and Department of Ophthalmology (J.A.F.), Western University, London, Ontario, Canada
| | - J Alexander Fraser
- From the Department of Clinical Neurological Sciences (C.M.L., K.M., J.A.F.), and Department of Ophthalmology (J.A.F.), Western University, London, Ontario, Canada
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Costello F, Hamann S. Advantages and Pitfalls of the Use of Optical Coherence Tomography for Papilledema. Curr Neurol Neurosci Rep 2024; 24:55-64. [PMID: 38261144 DOI: 10.1007/s11910-023-01327-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE OF REVIEW Papilledema refers to optic disc swelling caused by raised intracranial pressure. This syndrome arises from numerous potential causes, which may pose varying degrees of threat to patients. Manifestations of papilledema range from mild to severe, and early diagnosis is important to prevent vision loss and other deleterious outcomes. The purpose of this review is to highlight the role of optical coherence tomography (OCT) in the diagnosis and management of syndromes of raised intracranial pressure associated with papilledema. RECENT FINDINGS Ophthalmoscopy is an unreliable skill for many clinicians. Optical coherence tomography is a non-invasive ocular imaging technique which may fill a current care gap, by facilitating detection of papilledema for those who cannot perform a detailed fundus examination. Optical coherence tomography may help confirm the presence of papilledema, by detecting subclinical peripapillary retinal nerve fiber layer (pRNFL) thickening that might otherwise be missed with ophthalmoscopy. Enhanced depth imaging (EDI) and swept source OCT techniques may identify optic disc drusen as cause of pseudo-papilledema. Macular ganglion cell inner plexiform layer (mGCIPL) values may provide early signs of neuroaxonal injury in patients with papilledema and inform management for patients with syndromes of raised intracranial pressure. There are well-established advantages and disadvantages of OCT that need to be fully understood to best utilize this method for the detection of papilledema. Overall, OCT may complement other existing tools by facilitating detection of papilledema and tracking response to therapies. Moving forward, OCT findings may be included in deep learning models to diagnose papilledema.
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Affiliation(s)
- Fiona Costello
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.
- Department of Surgery, Cumming School of Medicine, University of Calgary, Alberta, Canada.
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
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Kaya Tutar N, Kale N. The Relationship between Lumbar Puncture Opening Pressure and Retinal Nerve Fiber Layer Thickness in the Diagnosis of Idiopathic Intracranial Hypertension: Is a Lumbar Puncture Always Necessary? Neurologist 2024; 29:91-95. [PMID: 37839079 DOI: 10.1097/nrl.0000000000000528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
OBJECTIVES Idiopathic intracranial hypertension (IIH), is characterized by elevated intracranial pressure (ICP) without an identified cause. Today, lumbar puncture (LP) is the most common method used for diagnosis by measuring cerebrospinal fluid (CSF) pressure to reflect intracranial pressure. This invasive examination has significant disadvantages, such as complications and negative experiences for patients. Therefore, noninvasive methods for ICP measurement are desired. Optical coherence tomography (OCT) is widely used for the diagnosis and follow-up of IIH patients as it reflects papilledema. The aim of this study is to investigate the relationship between CSF pressure and OCT parameters and the ability of OCT in the diagnostic approach. METHODS In our study, patients who were followed up with a diagnosis of IIH with complete neuro-ophthalmological examinations, including visual acuity (VA), visual field, and OCT imaging within 24 hours before lumbar puncture, were retrospectively evaluated. CSF pressure, visual acuity LogMAR, mean deviation of visual fields, retinal nerve fiber layer (RNFL) thickness measured by OCT, and treatment protocols were obtained from our hospital data system. RESULTS A total of 42 eyes of 21 patients were enrolled in the study. A statistically significant positive and moderate correlation was found between CSF pressure values and average RNFL thickness ( r =0.507; P =0.001). The same relationship was demonstrated in all 4 quadrants: inferior, superior, nasal, and temporal. CONCLUSIONS Increased peripapillary RNFL thickness in optic nerve head OCT may be correlated with increased ICP in IIH patients. A larger number of patients are needed to better understand the correlation between OCT parameters and CSF pressure in patients with IIH.
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Affiliation(s)
- Nurhan Kaya Tutar
- Department of Neurology, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Kerscher SR, Zipfel J, Haas-Lude K, Bevot A, Tellermann J, Schuhmann MU. Transorbital point-of-care ultrasound versus fundoscopic papilledema to support treatment indication for potentially elevated intracranial pressure in children. Childs Nerv Syst 2024; 40:655-663. [PMID: 37962632 PMCID: PMC10890976 DOI: 10.1007/s00381-023-06186-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 10/10/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE To compare transorbital point-of-care ultrasound techniques -optic nerve sheath diameter (US-ONSD) and optic disc elevation (US-ODE)- with fundoscopic papilledema to detect potentially raised intracranial pressure (ICP) with treatment indication in children. METHODS In a prospective study, 72 symptomatic children were included, 50 with later proven disease associated with raised ICP (e.g. pseudotumour cerebri, brain tumour, hydrocephalus) and 22 with pathology excluded. Bilateral US-ONSD and US-ODE were quantified by US using a 12-MHz-linear-array transducer. This was compared to fundoscopic optic disc findings (existence of papilledema) and, in 28 cases, invasively measured ICP values. RESULTS The sensitivity and specificity of a cut-off value of US-ONSD (5.73 mm) to detect treatment indication for diseases associated with increased ICP was 92% and 86.4%, respectively, compared to US-ODE (0.43 mm) with sensitivity: 72%, specificity: 77.3%. Fundoscopic papilledema had a sensitivity of 46% and a specificity of 100% in this context. Repeatability and observer-reliability of US-ODE examination was eminent (Cronbach's α = 0.978-0.989). Papilledema was detected fundoscopically only when US-ODE was > 0.67 mm; a US-ODE > 0.43 mm had a positive predictive value of 90% for potentially increased ICP. CONCLUSION In our cohort, transorbital point-of-care US-ONSD and US-ODE detected potentially elevated ICP requiring treatment in children more reliably than fundoscopy. US-ONSD and US-ODE indicated the decrease in ICP after treatment earlier and more reliably than fundoscopy. The established cut-off values for US-ONSD and US-ODE and a newly developed US-based grading of ODE can be used as an ideal first-line screening tool to detect or exclude conditions with potentially elevated ICP in children.
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Affiliation(s)
- Susanne Regina Kerscher
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany.
- Department of Neurosurgery, Division of Paediatric Neurosurgery, University Hospital of Tuebingen, Tübingen, Germany.
| | - Julian Zipfel
- Department of Neurosurgery, Division of Paediatric Neurosurgery, University Hospital of Tuebingen, Tübingen, Germany
| | - Karin Haas-Lude
- Department of Paediatric Neurology and Developmental Medicine, University Children's Hospital of Tuebingen, Tübingen, Germany
| | - Andrea Bevot
- Department of Paediatric Neurology and Developmental Medicine, University Children's Hospital of Tuebingen, Tübingen, Germany
| | - Jonas Tellermann
- Department of Neurosurgery, Division of Paediatric Neurosurgery, University Hospital of Tuebingen, Tübingen, Germany
| | - Martin Ulrich Schuhmann
- Department of Neurosurgery, Division of Paediatric Neurosurgery, University Hospital of Tuebingen, Tübingen, Germany
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Jiang Z, Shao W, Li W. The "Wrinkle Sign" in Time-of-Flight Magnetic Resonance Venography is a Hallmark of Idiopathic Intracranial Hypertension. World Neurosurg 2024; 183:204-205. [PMID: 38143030 DOI: 10.1016/j.wneu.2023.12.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 12/26/2023]
Abstract
Idiopathic intracranial hypertension (IIH) is usually caused by sinus stenosis, which manifests in magnetic resonance venography (MRV) as occlusion or intraluminal webbing. We present the case of a 27-year-old patient with IIH, and time-of-flight (TOF) MRV only exhibited a rare "wrinkle sign," which was eventually proved to indicate sinus obstruction. The patient received venting and recovered. The TOF MRV provides a nonradioactive approach to identify IIH patients who potentially need intervention.
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Affiliation(s)
- Zhouyang Jiang
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Wenyu Shao
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Wenyan Li
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing, China.
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Orillac C, Kremer CM, Harter DH. Sudden Tissue Pallor and Systemic Hypertension Correlated With Intraoperative Elevated Intracranial Pressure During Endoscopic Resection of an Exophytic Thalamic Mass: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2024; 26:352. [PMID: 37819103 DOI: 10.1227/ons.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 08/18/2023] [Indexed: 10/13/2023] Open
Affiliation(s)
- Cordelia Orillac
- Department of Neurosurgery, NYU Langone Health, New York , New York , USA
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Xu J, Song Y, Shah Nayaz BM, Shi W, Zhao Y, Liu Y, Wu S, Li Z, Sun Y, Zhao Y, Yu W, Wang X. Optic Nerve Sheath Diameter Sonography for the Diagnosis of Intracranial Hypertension in Traumatic Brain Injury: A Systematic Review and Meta-Analysis. World Neurosurg 2024; 182:136-143. [PMID: 37951461 DOI: 10.1016/j.wneu.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Timely diagnosis and management of elevated intracranial pressure (ICP) in patients with traumatic brain injury (TBI) can significantly reduce mortality rates. Ultrasound examination of the optic nerve sheath diameter (ONSD) is considered a potential, noninvasive, and effective method for assessing ICP. We conducted a systematic review and meta-analysis of ONSD ultrasound detection and invasive ICP monitoring methods to compare and evaluate the diagnostic accuracy of ONSD ultrasound detection methods for intracranial hypertension (IH) in patients with TBI. METHODS We searched the Web of Science, PubMed, and Embase databases to assess the diagnostic accuracy of ONSD sonography for predicting increased ICP. The 2 authors independently extracted the collected data. Simultaneously, the QUADAS-2 tool was used to evaluate the bias risk of each study and conducted random-effects meta-analyses for the accuracy and specificity of diagnosis, and calculated pooled estimates. RESULTS Ten studies with 512 patients were included. The diagnostic accuracy of ONSD sonography for IH was revealed as a pooled sensitivity of 0.85 (95% confidence interval [CI], 0.79-0.89) and specificity of 0.88 (95% CI, 0.80-0.93), compared with the invasive ICP monitoring standard for patients with TBI. CONCLUSIONS ONSD sonography may be a useful method for predicting increased ICP in adult patients with TBI. Further clinical studies are required to confirm the diagnostic value of ONSD sonography.
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Affiliation(s)
- Jie Xu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China; Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China; Department of Critical Care Medicine, Xuzhou First People's Hospital, Xuzhou, China
| | - Yinghua Song
- Department of Pharmaceutical Engineering, Jiangsu Provincial Xuzhou Pharmaceutical Vocational College, Xuzhou, China
| | - Burkutally Muhammad Shah Nayaz
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science Technology, Wuhan, China
| | - Weitao Shi
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China; Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yun Zhao
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China; Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yawen Liu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China; Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
| | - Suming Wu
- Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
| | - Zhi Li
- Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yanhu Sun
- Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yuliang Zhao
- Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China
| | - Wenkui Yu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, Nanjing, China
| | - Xudong Wang
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China; Department of Critical Care Medicine, The Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University, Xuzhou, China.
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Schmill LPA, Peters S, Juhász J, Jansen O, Laudes M, Aludin S. MRI signs of intracranial hypertension in morbidly obese and normal-weight individuals. ROFO-FORTSCHR RONTG 2024; 196:176-185. [PMID: 37963551 DOI: 10.1055/a-2114-1919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE Idiopathic intracranial hypertension (IIH) is associated with intracranial abnormalities, although not obligatory, which can be detected with cranial MRI. Obesity is an important risk factor for IIH and a pathogenetic link is suspected but the extent to which these MRI signs are already related to obesity has not yet been examined. We investigated whether IIH-MRI signs are present more often in obese individuals with a BMI > 30 kg/m² than in individuals of normal weight. MATERIALS AND METHODS Brain MRI of 32 obese and 53 normal-weight participants from the Food-Chain-Plus cohort were analyzed for three main signs of IIH: (I) stenosis of the transverse sinus, (II) increased width of the optic nerve sheath, and (III) reduction of pituitary height. In addition, a scoring system for the MRI signs was applied. Furthermore, tortuosity of the optic nerve and flattening of the posterior globe were considered as additional MRI signs. RESULTS Obese participants had a significantly higher MRI score (p < 0.001) than those in the normal-weight cohort, with significant differences in quantitative measurements of cerebral venous sinus stenosis (p < 0.001), widening of the optic nerve sheath (p < 0.05), and flattening of the pituitary gland (p < 0.05) also always being observed more frequently and in a more pronounced manner in the obese group. Furthermore, our findings correlated significantly with BMI and proportionately with hip and waist circumference. CONCLUSION Obese individuals show a significantly higher prevalence of cerebral MRI signs related to IIH. This supports the hypothesis that obesity is a risk factor for possible intracranial hypertension and reinforces the suspicion that obesity is involved in the pathomechanism of IIH. KEY POINTS · Obesity is associated with changes such as those seen in IIH.. · BMI, weight, and body measurements correlate with the expression of MRI signs of IIH.. · To prevent IIH symptoms in obesity, the pathomechanism must be further clarified..
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Affiliation(s)
| | - Sönke Peters
- Clinic for Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany
| | - Julia Juhász
- Clinic for Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany
| | - Olav Jansen
- Clinic for Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany
| | - Matthias Laudes
- Institute of Diabetes and Clinical Metabolic Research; Division of Endocrinology, Diabetes and Clinical Nutrition, Department of Medicine 1, University Hospital Schleswig-Holstein - Campus Kiel, Germany
| | - Schekeb Aludin
- Clinic for Radiology and Neuroradiology, University Hospital Schleswig-Holstein - Campus Kiel, Germany
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Chesnut R, Temkin N, Pridgeon J, Sulzbacher S, Lujan S, Videtta W, Moya-Barquín L, Chaddock K, Bonow RH, Petroni G, Guadagnoli N, Hendrickson P, Ramírez Cortez G, Carreazo NY, Vargas Aymituma A, Anchante D, Caqui P, Ramírez A, Munaico Abanto M, Ortiz Chicchon M, Cenzano Ramos J, Castro Darce MDC, Sierra Morales R, Brol Lopez P, Menendez W, Posadas Gutierrez S, Kevin V, Mazariegos A, de Leon E, Rodas Barrios RE, Rodríguez S, Flores S, Alvarado O, Guzman Flores LJ, Moisa Martinez M, Gonzalez P. Development of a Randomized Trial Comparing ICP-Monitor-Based Management of Severe Pediatric Traumatic Brain Injury to Management Based on Imaging and Clinical Examination Without ICP Monitoring-Research Algorithms. Neurosurgery 2024; 94:72-79. [PMID: 37955439 DOI: 10.1227/neu.0000000000002760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/25/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The efficacy of our current approach to incorporating intracranial pressure (ICP) data into pediatric severe traumatic brain injury (sTBI) management is incompletely understood, lacking data from multicenter, prospective, randomized studies. The National Institutes of Health-supported Benchmark Evidence from Latin America-Treatment of Raised Intracranial Pressure-Pediatrics trial will compare outcomes from pediatric sTBI of a management protocol based on ICP monitoring vs 1 based on imaging and clinical examination without monitoring. Because no applicable comprehensive management algorithms for either cohort are available, it was necessary to develop them. METHODS A consensus conference involving the 21 intensivists and neurosurgeons from the 8 trial sites used Delphi-based methodology to formulate management algorithms for both study cohorts. We included recommendations from the latest Brain Trauma Foundation pediatric sTBI guidelines and the consensus-based adult algorithms (Seattle International Brain Injury Consensus Conference/Consensus Revised Imaging and Clinical Examination) wherever relevant. We used a consensus threshold of 80%. RESULTS We developed comprehensive management algorithms for monitored and nonmonitored cohort children with sTBI. We defined suspected intracranial hypertension for the nonmonitored group, set minimum number and timing of computed tomography scans, specified minimal age-adjusted mean arterial pressure and cerebral perfusion pressure targets, defined clinical neuroworsening, described minimal requisites for intensive care unit management, produced tiered management algorithms for both groups, and listed treatments not routinely used. CONCLUSION We will study these protocols in the Benchmark Evidence from Latin America-Treatment of Raised Intracranial Pressure-Pediatrics trial in low- and middle-income countries. Second, we present them here for consideration as prototype pediatric sTBI management algorithms in the absence of published alternatives, acknowledging their limited evidentiary status. Therefore, herein, we describe our study design only, not recommended treatment protocols.
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Affiliation(s)
- Randall Chesnut
- Department of Neurological Surgery, University of Washington, Seattle , Washington , USA
- Department of Orthopaedic Surgery, University of Washington, Seattle , Washington , USA
- School of Global Health, University of Washington, Seattle , Washington , USA
- Harborview Medical Center, University of Washington, Seattle , Washington , USA
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle , Washington , USA
- Department of Biostatistics, University of Washington, Seattle , Washington , USA
| | - James Pridgeon
- Department of Neurological Surgery, University of Washington, Seattle , Washington , USA
| | - Stephen Sulzbacher
- Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle , Washington , USA
| | - Silvia Lujan
- Hospital Emergencia, Dr. Clemente Alvarez, Rosario , Argentina
- Centro de Informatica e Investigacion Clinica, Rosario , Argentina
| | - Walter Videtta
- Medicina Intensiva, Hospital Nacional Professor Alejandro Posadas, Buenos Aires , Argentina
| | | | - Kelley Chaddock
- Department of Neurological Surgery, University of Washington, Seattle , Washington , USA
| | - Robert H Bonow
- Department of Neurological Surgery, University of Washington, Seattle , Washington , USA
| | - Gustavo Petroni
- Hospital Emergencia, Dr. Clemente Alvarez, Rosario , Argentina
- Centro de Informatica e Investigacion Clinica, Rosario , Argentina
| | - Nahuel Guadagnoli
- Hospital Emergencia, Dr. Clemente Alvarez, Rosario , Argentina
- Centro de Informatica e Investigacion Clinica, Rosario , Argentina
| | - Peter Hendrickson
- Department of Neurological Surgery, University of Washington, Seattle , Washington , USA
| | | | - Nilton Yhuri Carreazo
- Hospital de Emergencias Pediátricas, Lima , Peru
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima , Peru
| | | | - Daniel Anchante
- Instituto Nacional de Salud del Niño - San Borja, Lima , Peru
| | - Patrick Caqui
- Instituto Nacional de Salud del Niño - San Borja, Lima , Peru
| | - Alberto Ramírez
- Instituto Nacional de Salud del Niño - San Borja, Lima , Peru
| | | | | | | | | | | | | | | | | | - Vicente Kevin
- Hospital Regional de Esquintla, Esquintla , Guatemala
| | - Andrea Mazariegos
- Hospital Regional de Occidente San Juan de Dios, Quetzaltenango , Guatemala
| | - Elie de Leon
- Hospital Regional de Occidente San Juan de Dios, Quetzaltenango , Guatemala
| | | | | | - Sandra Flores
- Hospital Escuela Universitario, Tegucigalpa , Hondeuras
| | | | | | | | - Pablo Gonzalez
- Hospital de Niños Benjamín Bloom, San Salvador , El Salvador
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Chesnut R, Temkin N, Pridgeon J, Sulzbacher S, Lujan S, Videtta W, Moya-Barquín L, Chaddock K, Bonow R, Petroni G, Guadagnoli N, Hendrickson P, Ramírez Cortez G, Carreazo NY, Vargas Aymituma A, Anchante D, Caqui P, Ramírez A, Munaico Abanto M, Ortiz Chicchon M, Cenzano Ramos J, Mazate-Mazariegos A, Castro Darce MDC, Sierra Morales R, Brol Lopez P, Menendez W, Posadas Gutierrez S, Kevin V, Mazariegos A, de Leon E, Rodas Barrios RE, Rodríguez S, Flores S, Alvarado O, Guzman Flores LJ, Moisa Martinez M, Gonzalez P. Development of a Randomized Trial Comparing ICP-Monitor-Based Management of Severe Pediatric Traumatic Brain Injury to Management Based on Imaging and Clinical Examination Without ICP Monitoring-Study Protocol. Neurosurgery 2024; 94:65-71. [PMID: 37409817 DOI: 10.1227/neu.0000000000002582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Traumatic brain injury (TBI) is a major global public health problem. It is a leading cause of death and disability in children and adolescents worldwide. Although increased intracranial pressure (ICP) is common and associated with death and poor outcome after pediatric TBI, the efficacy of current ICP-based management remains controversial. We intend to provide Class I evidence testing the efficacy of a protocol based on current ICP monitor-based management vs care based on imaging and clinical examination without ICP monitoring in pediatric severe TBI. METHODS A phase III, multicenter, parallel-group, randomized superiority trial performed in intensive care units in Central and South America to determine the impact on 6-month outcome of children aged 1-12 years with severe TBI (age-appropriate Glasgow Coma Scale score ≤8) randomized to ICP-based or non-ICP-based management. EXPECTED OUTCOMES Primary outcome is 6-month Pediatric Quality of Life. Secondary outcomes are 3-month Pediatric Quality of Life, mortality, 3-month and 6-month Pediatric extended Glasgow Outcome Score, intensive care unit length of stay, and number of interventions focused on treating measured or suspected intracranial hypertension. DISCUSSION This is not a study of the value of knowing the ICP in sTBI. This research question is protocol-based. We are investigating the added value of protocolized ICP management to treatment based on imaging and clinical examination in the global population of severe pediatric TBI. Demonstrating efficacy should standardize ICP monitoring in severe pediatric TBI. Alternate results should prompt reassessment of how and in which patients ICP data should be applied in neurotrauma care.
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Affiliation(s)
- Randall Chesnut
- Department of Neurological Surgery, University of Washington, Seattle , Washington , USA
- Department of Orthopaedic Surgery, University of Washington, Seattle , Washington , USA
- School of Global Health, University of Washington, Seattle , Washington , USA
- Harborview Medical Center, University of Washington, Seattle , Washington , USA
| | - Nancy Temkin
- Department of Neurological Surgery, University of Washington, Seattle , Washington , USA
- Department of Biostatistics, University of Washington, Seattle , Washington , USA
| | - James Pridgeon
- Department of Neurological Surgery, University of Washington, Seattle , Washington , USA
| | - Stephen Sulzbacher
- Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle , Washington , USA
| | - Silvia Lujan
- Hospital Emergencia, Dr. Clemente Alvarez, Rosario , Argentina
- Centro de Informatica e Investigacion Clinica, Rosario , Argentina
| | - Walter Videtta
- Medicina Intensiva, Hospital Nacional Professor Alejandro Posadas, Buenos Aires , Argentina
| | | | - Kelley Chaddock
- Department of Neurological Surgery, University of Washington, Seattle , Washington , USA
| | - Robert Bonow
- Department of Neurological Surgery, University of Washington, Seattle , Washington , USA
| | - Gustavo Petroni
- Hospital Emergencia, Dr. Clemente Alvarez, Rosario , Argentina
- Centro de Informatica e Investigacion Clinica, Rosario , Argentina
| | - Nahuel Guadagnoli
- Hospital Emergencia, Dr. Clemente Alvarez, Rosario , Argentina
- Centro de Informatica e Investigacion Clinica, Rosario , Argentina
| | - Peter Hendrickson
- Department of Neurological Surgery, University of Washington, Seattle , Washington , USA
| | | | - Nilton Yhuri Carreazo
- Hospital de Emergencias Pediátricas, Lima , Peru
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima , Peru
| | | | - Daniel Anchante
- Instituto Nacional de Salud del Niño - San Borja, Lima , Peru
| | - Patrick Caqui
- Instituto Nacional de Salud del Niño - San Borja, Lima , Peru
| | - Alberto Ramírez
- Instituto Nacional de Salud del Niño - San Borja, Lima , Peru
| | | | | | | | | | | | | | | | | | | | - Vicente Kevin
- Hospital Regional de Esquintla, Esquintla , Guatemala
| | - Andrea Mazariegos
- Hospital Regional de Occidente San Juan de Dios, Quetzaltenango , Guatemala
| | - Elie de Leon
- Hospital Regional de Occidente San Juan de Dios, Quetzaltenango , Guatemala
| | | | | | - Sandra Flores
- Hospital Escuela Universitario, Tegucigalpa , Honduras
| | | | | | | | - Pablo Gonzalez
- Hospital de Niños Benjamín Bloom, San Salvador , El Salvador
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14
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Singh M, Gupta V, Gupta R, Kumar B, Agrawal D. A Novel Method for Prediction of Raised Intracranial Pressure Through Automated ONSD and ETD Ratio Measurement From Ocular Ultrasound. Ultrason Imaging 2024; 46:29-40. [PMID: 37698256 DOI: 10.1177/01617346231197593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
The paper presents a novel framework for the prediction of the raised Intracranial Pressure (ICP) from ocular ultrasound images of traumatic patients through automated measurement of Optic Nerve Sheath Diameter (ONSD) and Eyeball Transverse Diameter (ETD). The measurement of ONSD using an ocular ultrasound scan is non-invasive and correlates with the raised ICP. However, the existing studies suggested that the ONSD value alone is insufficient to indicate the ICP condition. Since the ONSD and ETD values may vary among patients belonging to different ethnicity/origins, there is a need for developing an independent global biomarker for predicting raised ICP condition. The proposed work develops an automated framework for the prediction of raised ICP by developing algorithms for the automated measurement of ONSD and ETD values. It is established that the ONSD and ETD ratio (OER) is a potential biomarker for ICP prediction independent of ethnicity and origin. The OER threshold value is determined by performing statistical analysis on the data of 57 trauma patients obtained from the AIIMS, New Delhi. The automated OER is computed and compared with the conventionally measured ICP by determining suitable correlation coefficients. It is found that there is a significant correlation of OER with ICP (r = .81, p ≤ .01), whereas the correlation of ONSD alone with ICP is relatively less (r = .69, p = .004). These correlation values indicate that OER is a better parameter for the prediction of ICP. Further, the threshold value of OER is found to be 0.21 for predicting raised ICP conditions in this study. Scatter plot and Heat map analysis of OER and corresponding ICP reveal that patients with OER ≥ 0.21, have ICP in the range of 17 to 35 mm Hg. In the data available for this research work, OER ranges from 0.17 to 0.35.
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Affiliation(s)
- Maninder Singh
- Electronics and Communication Engineering Department, Motilal Nehru National Institute of Technology Allahabad, Prayagraj, India
| | | | - Rajeev Gupta
- Electronics and Communication Engineering Department, Motilal Nehru National Institute of Technology Allahabad, Prayagraj, India
| | - Basant Kumar
- Electronics and Communication Engineering Department, Motilal Nehru National Institute of Technology Allahabad, Prayagraj, India
| | - Deepak Agrawal
- JPNATC, All India Institute of Medical Sciences, New Delhi, India
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Cheng H, Jin H, Hu Y, Chen L, Chen Z, Zhong G. Long-term efficacy of venous sinus stenting in the treatment of idiopathic intracranial hypertension. CNS Neurosci Ther 2024; 30:e14356. [PMID: 37469247 PMCID: PMC10805447 DOI: 10.1111/cns.14356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/22/2023] [Accepted: 07/01/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUNDS Previous studies have suggested that cerebral dural sinus stenosis could be a possible underlying cause of idiopathic intracranial hypertension (IIH). Venous sinus stenting (VSS) has emerged as a potential alternative for treating IIH related to dural sinus stenosis. However, most of the documented studies have been conducted in Western countries. In this study, we present the results of 16 Chinese IIH patients who underwent VSS treatment in our single center. METHODS We prospectively collected angiographic and manometric data from IIH patients who underwent angioplasty/stenting. All patients had confirmed dural sinus stenosis and had failed maximal medical therapy (MMT). Demographic, clinical, and radiological presentation, as well as long-term follow-up outcomes were collected retrospectively. RESULTS A total of 16 patients who underwent VSS were enrolled in the present study. Demographic data revealed a mean age of 40 (range 20-55), with 69% (11/16) being female, and a mean body mass index (BMI) of 27.05 (range 19.18-38.04) kg/m2 . All patients presented with papilledema and visual disturbances. During a median follow-up period of 47.5 months, 93.75% (15/16) of patients reported improvement in symptoms, although only 37.5% (6/16) experienced complete resolution. Headaches, blurred vision, and amaurosis related to increased pressure improved in 100% (8/8), 81.25% (13/16), and 75% (3/4) of patients, respectively. However, one patient suffered cerebral infarction and secondary epilepsy soon after VSS, and another patient had recurrence of symptoms due to stent wall thrombosis 2 years later. CONCLUSIONS The significance of venous sinus stenosis in the development of IIH may be undervalued. Our study, based on a Chinese case series, affirms the long-term safety and effectiveness of VSS in treating IIH patients with relatively lower BMI than those from Western countries.
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Affiliation(s)
- Hui Cheng
- Department of Neurology, School of Medicine, Sir Run Run Shaw HospitalZhejiang UniversityHangzhouChina
| | - Haidi Jin
- Department of Neurology, School of Medicine, The Second Affiliated HospitalZhejiang UniversityHangzhouChina
| | - Yongjun Hu
- Department of Neurology, School of Medicine, The Second Affiliated HospitalZhejiang UniversityHangzhouChina
| | - Lijiang Chen
- Department of Neurology, School of Medicine, The Second Affiliated HospitalZhejiang UniversityHangzhouChina
| | - Zhicai Chen
- Department of Neurology, School of Medicine, The Second Affiliated HospitalZhejiang UniversityHangzhouChina
| | - Genlong Zhong
- Department of NeurologyThe Sixth Affiliated Hospital of Wenzhou Medical UniversityLishuiChina
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16
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Janitschke D, Stögbauer J, Lattanzi S, Brigo F, Lochner P. B-mode transorbital ultrasonography for the diagnosis of idiopathic intracranial hypertension: an updated systematic review and meta-analysis. Neurol Sci 2023; 44:4313-4322. [PMID: 37599314 DOI: 10.1007/s10072-023-07016-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis aimed to evaluate the role of B-mode transorbital ultrasonography (TOS) for the diagnosis of idiopathic intracranial hypertension (IIH) in adults. METHODS MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) (1966-May 2022) were searched to identify studies reporting ultrasonographic data about the optic nerve sheath diameter (ONSD) and optic disc elevation (ODE) in adults with IIH compared to subjects without IIH. The quality of the included studies was evaluated by the Newcastle-Ottawa Quality. RESULTS Fifteen studies were included (total of 439 patients). The values of ODE ranged from 0.6 to 1.3 mm in patients with IIH. The values of ONSD ranged from 4.7 to 6.8 mm in IIH patients and from 3.9 to 5.7 mm in controls. In IIH patients, the ONSD was significantly higher compared to controls (standardized mean difference: 2.5 mm, 95% confidence interval (CI): 1.6-3.4 mm). Nine studies provided data about the presence of papilledema and the pooled prevalence was 95% (95% CI, 92-97%). CONCLUSIONS In adults, the thickness of ONSD and the entity of ODE were significantly associated with IIH. B-mode TOS enables to noninvasively detect increased ICP and should be performed, potentially routinely, in any patient with suspected IIH.
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Affiliation(s)
- Daniel Janitschke
- Department of Neurology, Saarland University Medical Center, 66421, Homburg, Germany
| | - Jakob Stögbauer
- Department of Neurology, Saarland University Medical Center, 66421, Homburg, Germany
| | - Simona Lattanzi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy
- Innovation, Research and Teaching Service (SABES-ASDAA), Bolzano-Bozen, Italy
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, 66421, Homburg, Germany.
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17
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Frontera JA, Fang T, Grayson K, Lalchan R, Dickstein L, Hussain MS, Kahn DE, Lord AS, Mazzuchin D, Melmed KR, Rutledge C, Zhou T, Lewis A. Poor Accuracy of Manually Derived Head Computed Tomography Parameters in Predicting Intracranial Hypertension After Nontraumatic Intracranial Hemorrhage. Neurocrit Care 2023; 39:677-689. [PMID: 36577900 DOI: 10.1007/s12028-022-01662-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The utility of head computed tomography (CT) in predicting elevated intracranial pressure (ICP) is known to be limited in traumatic brain injury; however, few data exist in patients with spontaneous intracranial hemorrhage. METHODS We conducted a retrospective review of prospectively collected data in patients with nontraumatic intracranial hemorrhage (subarachnoid hemorrhage [SAH] or intraparenchymal hemorrhage [IPH]) who underwent external ventricular drain (EVD) placement. Head CT scans performed immediately prior to EVD placement were quantitatively reviewed for features suggestive of elevated ICP, including temporal horn diameter, bicaudate index, basal cistern effacement, midline shift, and global cerebral edema. The modified Fisher score (mFS), intraventricular hemorrhage score, and IPH volume were also measured, as applicable. We calculated the accuracy, positive predictive value (PPV), and negative predictive value (NPV) of these radiographic features for the coprimary outcomes of elevated ICP (> 20 mm Hg) at the time of EVD placement and at any time during the hospital stay. Multivariable backward stepwise logistic regression analysis was performed to identify significant radiographic factors associated with elevated ICP. RESULTS Of 608 patients with intracranial hemorrhages enrolled during the study time frame, 243 (40%) received an EVD and 165 (n = 107 SAH, n = 58 IPH) had a preplacement head CT scan available for rating. Elevated opening pressure and elevated ICP during hospitalization were recorded in 48 of 152 (29%) and 103 of 165 (62%), respectively. The presence of ≥ 1 radiographic feature had only 32% accuracy for identifying elevated opening pressure (PPV 30%, NPV 58%, area under the curve [AUC] 0.537, 95% asymptotic confidence interval [CI] 0.436-0.637, P = 0.466) and 59% accuracy for predicting elevated ICP during hospitalization (PPV 63%, NPV 40%, AUC 0.514, 95% asymptotic CI 0.391-0.638, P = 0.820). There was no significant association between the number of radiographic features and ICP elevation. Head CT scans without any features suggestive of elevated ICP occurred in 25 of 165 (15%) patients. However, 10 of 25 (40%) of these patients had elevated opening pressure, and 15 of 25 (60%) had elevated ICP during their hospital stay. In multivariable models, mFS (adjusted odds ratio [aOR] 1.36, 95% CI 1.10-1.68) and global cerebral edema (aOR 2.93, 95% CI 1.27-6.75) were significantly associated with elevated ICP; however, their accuracies were only 69% and 60%, respectively. All other individual radiographic features had accuracies between 38 and 58% for identifying intracranial hypertension. CONCLUSIONS More than 50% of patients with spontaneous intracranial hemorrhage without radiographic features suggestive of elevated ICP actually had ICP > 20 mm Hg during EVD placement or their hospital stay. Morphological head CT findings were only 32% and 59% accurate in identifying elevated opening pressure and ICP elevation during hospitalization, respectively.
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Affiliation(s)
- Jennifer A Frontera
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA.
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA.
- Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Taolin Fang
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
| | - Kammi Grayson
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
| | - Rebecca Lalchan
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
| | - Leah Dickstein
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - M Shazam Hussain
- Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - D Ethan Kahn
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
| | - Aaron S Lord
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
| | - Daniel Mazzuchin
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Kara R Melmed
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Caleb Rutledge
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Ting Zhou
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
| | - Ariane Lewis
- Department of Neurology, New York University School of Medicine, 150 55th St., Brooklyn, New York, NY, USA
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
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18
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Kwapong WR, Cao L, Pan R, Wang H, Ye C, Tao W, Liu J, Wu B. Retinal microvascular and structural changes in intracranial hypertension patients correlate with intracranial pressure. CNS Neurosci Ther 2023; 29:4093-4101. [PMID: 37287365 PMCID: PMC10651994 DOI: 10.1111/cns.14298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/23/2023] [Accepted: 05/26/2023] [Indexed: 06/09/2023] Open
Abstract
AIMS We aimed to evaluate the retinal microvascular and structural changes in intracranial hypertension (IH) patients compared with an age- and sex-matched control group. We also investigated the association between clinical parameters and retinal changes in IH patients. METHODS Intracranial hypertension patients were divided into eyes with papilledema (IH-P) and eyes without papilledema (IH-WP). IH patients underwent lumbar puncture to measure intracranial pressure (ICP); visual acuity was performed using the Snellen chart. Optical coherence tomography (OCT) was used to image and measure the retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) while OCT angiography was used to image and measure the superficial vascular complex (SVC) and deep vascular complex (DVC). RESULTS Intracranial hypertension patients showed reduced microvascular densities and thinner retinal thicknesses compared with the control group (all p < 0.001). Compared with the control group, IH-P showed reduced microvascular densities and thinner retinal thicknesses (all p < 0.001). IH-P showed reduced SVC density and thinner retinal thicknesses when compared with IH-WP (p = 0.008 for SVC, p = 0.025 for RNFL, and p = 0.018 for GCIPL). ICP correlated with the microvascular densities and GCIPL thickness in IH patients (p = 0.025 for GCIPL, p = 0.004 for SVC, and p = 0.002 for DVC). A significant association of ICP with SVC (p = 0.010) and DVC (p = 0.005) densities were also found in IH-P. CONCLUSIONS Given the observed differences in these noninvasive retinal imaging markers, further research into their clinical utility in IH is needed.
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Affiliation(s)
| | - Le Cao
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Ruosu Pan
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Hang Wang
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Chen Ye
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Wendan Tao
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Junfeng Liu
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
| | - Bo Wu
- Department of Neurology, West China HospitalSichuan UniversityChengduChina
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19
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Berhanu D, Ferreira JC, Abegão Pinto L, Aguiar de Sousa D, Lucas Neto L, Tavares Ferreira J. The role of optic nerve sheath ultrasonography in increased intracranial pressure: A systematic review and meta analysis. J Neurol Sci 2023; 454:120853. [PMID: 37925899 DOI: 10.1016/j.jns.2023.120853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/22/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES To review the optimal diagnostic cut-off of ultrasonographic optic nerve sheath diameter (ONSD) in the diagnosis of increased intracranial pressure (IICP). METHODS A systematic search was conducted of available studies assessing the use of ONSD ultrasonography in patients with suspected IICP. Meta-analysis of diagnostic accuracy of ultrasonographic ONSD was performed using a bivariate model of random effects to summarize pooled sensitivity and specificity. A summary receiver operating characteristics (SROC) curve was plotted. Accuracy measures associated with ONSD cut-off and predefined covariates were investigated with meta-regression. RESULTS We included 38 studies, comprising a total of 2824 patients. A total of 21 studies used invasive techniques as a reference standard estimation of IICP and meta-analysis revealed a pooled sensitivity of 0.90 (95% CI 0.85-0.93) and specificity of 0.87 (95% CI 0.80-0.91). Optimal ONSD cut-off values ranged between 4.1 mm and 7.2 mm. Meta-regression analysis showed that ONSD cut-off values of 5.6 to 6.3 mm were associated with higher pooled specificity compared to cut-off values of 4.9 to 5.5 mm (0.93, 95% CI 0.85-0.97 vs. 0.78, 95% CI 0.65-0.87; p = 0.036). CONCLUSIONS Ultrasonography of ONSD shows a high diagnostic accuracy for IICP, with high pooled sensitivity and specificity. Additionally, larger cut-off values seem to significantly increase specificity without compromising sensitivity, which support their use as optimal ONSD cut-off. The overall high sensitivity of ultrasonographic ONSD suggests its usefulness as a screening tool for IIC, which may provide an estimate of when invasive methods are warranted. CLINICAL RELEVANCE ONSD ultrasonography is a fast and cost-effective method with a high diagnostic accuracy to detect IICP. The optimum ONSD cut-off hasn't been established before, but we suggest the 5.6 to 6.3 mm range as the best for the diagnosis of IICP.
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Affiliation(s)
- David Berhanu
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Serviço de Imagiologia Neurológica, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal.
| | | | - Luís Abegão Pinto
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Serviço de Oftalmologia, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Diana Aguiar de Sousa
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Unidade Cerebrovascular, Centro Hospitalar Universitário Lisboa Central, Lisboa, Portugal
| | - Lia Lucas Neto
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Serviço de Imagiologia Neurológica, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Joana Tavares Ferreira
- Faculdade de Medicina da Universidade de Lisboa, Lisboa, Portugal; Serviço de Oftalmologia, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
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Kahan J, Ong H, Elnaas H, Ch'ang JH, Murthy SB, Merkler AE, Sabuncu MR, Gupta A, Kamel H. Optic Nerve Diameter on Non-Contrast Computed Tomography and Intracranial Hypertension in Patients With Acute Brain Injury: A Validation Study. J Neurotrauma 2023; 40:2282-2288. [PMID: 37212270 PMCID: PMC10775921 DOI: 10.1089/neu.2023.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023] Open
Abstract
Intracranial hypertension is a feared complication of acute brain injury that can cause ischemic stroke, herniation, and death. Identifying those at risk is difficult, and the physical examination is often confounded. Given the widespread availability and use of computed tomography (CT) in patients with acute brain injury, prior work has attempted to use optic nerve diameter measurements to identify those at risk of intracranial hypertension. We aimed to validate the use of optic nerve diameter measurements on CT as a screening tool for intracranial hypertension in a large cohort of brain-injured patients. We performed a retrospective observational cohort study in a single tertiary referral Neuroscience Intensive Care Unit. We identified patients with documented intracranial pressure (ICP) measures as part of their routine clinical care who had non-contrast CT head scans collected within 24 h, and then measured the optic nerve diameters and explored the relationship and test characteristics of these measures to identify those at risk of intracranial hypertension. In a cohort of 314 patients, optic nerve diameter on CT was linearly but weakly associated with ICP. When used to identify those with intracranial hypertension (> 20 mm Hg), the area under the receiver operator curve (AUROC) was 0.68. Using a previously proposed threshold of 0.6 cm, the sensitivity was 81%, specificity 43%, positive likelihood ratio 1.4, and negative likelihood ratio 0.45. CT-derived optic nerve diameter using a threshold of 0.6 cm is sensitive but not specific for intracranial hypertension, and the overall correlation is weak.
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Affiliation(s)
- Joshua Kahan
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Hanley Ong
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Hailan Elnaas
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Judy H. Ch'ang
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Santosh B. Murthy
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Alexander E. Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
| | - Mert R. Sabuncu
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
- School of Electrical and Computer Engineering, Cornell University and Cornell Tech, New York, New York, USA
| | - Ajay Gupta
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, New York, USA
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21
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de Moraes FM, Adissy ENB, Rocha E, Barros FCD, Freitas FGR, Miranda M, Valiente RA, de Andrade JBC, Chaddad-Neto FEA, Silva GS. Multimodal monitoring intracranial pressure by invasive and noninvasive means. Sci Rep 2023; 13:18404. [PMID: 37891406 PMCID: PMC10611734 DOI: 10.1038/s41598-023-45834-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/24/2023] [Indexed: 10/29/2023] Open
Abstract
Although the placement of an intraventricular catheter remains the gold standard method for the diagnosis of intracranial hypertension (ICH), the technique has several limitations including but not limited to its invasiveness. Current noninvasive methods, however, still lack robust evidence to support their clinical use. We aimed to estimate, as an exploratory hypothesis generating analysis, the discriminative power of four noninvasive methods to diagnose ICH. We prospectively collected data from adult intensive care unit (ICU) patients with subarachnoid hemorrhage (SAH), intraparenchymal hemorrhage (IPH), and ischemic stroke (IS) in whom invasive intracranial pressure (ICP) monitoring had been placed. Measures were simultaneously collected from the following noninvasive methods: optic nerve sheath diameter (ONSD), pulsatility index (PI) using transcranial Doppler (TCD), a 5-point visual scale designed for brain Computed Tomography (CT), and two parameters (time-to-peak [TTP] and P2/P1 ratio) of a noninvasive ICP wave morphology monitor (Brain4Care[B4c]). ICH was defined as a sustained ICP > 20 mmHg for at least 5 min. We studied 18 patients (SAH = 14; ICH = 3; IS = 1) on 60 occasions with a mean age of 52 ± 14.3 years. All methods were recorded simultaneously, except for the CT, which was performed within 24 h of the other methods. The median ICP was 13 [9.8-16.2] mmHg, and intracranial hypertension was present on 18 occasions (30%). Median values from the noninvasive techniques were ONSD 4.9 [4.40-5.41] mm, PI 1.22 [1.04-1.43], CT scale 3 points [IQR: 3.0], P2/P1 ratio 1.16 [1.09-1.23], and TTP 0.215 [0.193-0.237]. There was a significant statistical correlation between all the noninvasive techniques and invasive ICP (ONSD, r = 0.29; PI, r = 0.62; CT, r = 0.21; P2/P1 ratio, r = 0.35; TTP, r = 0.35, p < 0.001 for all comparisons). The area under the curve (AUC) to estimate intracranial hypertension was 0.69 [CIs = 0.62-0.78] for the ONSD, 0.75 [95% CIs 0.69-0.83] for the PI, 0.64 [95%Cis 0.59-069] for CT, 0.79 [95% CIs 0.72-0.93] for P2/P1 ratio, and 0.69 [95% CIs 0.60-0.74] for TTP. When the various techniques were combined, an AUC of 0.86 [0.76-0.93]) was obtained. The best pair of methods was the TCD and B4cth an AUC of 0.80 (0.72-0.88). Noninvasive technique measurements correlate with ICP and have an acceptable discrimination ability in diagnosing ICH. The multimodal combination of PI (TCD) and wave morphology monitor may improve the ability of the noninvasive methods to diagnose ICH. The observed variability in non-invasive ICP estimations underscores the need for comprehensive investigations to elucidate the optimal method-application alignment across distinct clinical scenarios.
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Affiliation(s)
| | | | - Eva Rocha
- Neurology and Neurosurgery Department, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Maramelia Miranda
- Neurology and Neurosurgery Department, Federal University of São Paulo, São Paulo, Brazil
| | - Raul Alberto Valiente
- Neurology and Neurosurgery Department, Federal University of São Paulo, São Paulo, Brazil
| | | | | | - Gisele Sampaio Silva
- Neurology and Neurosurgery Department, Federal University of São Paulo, São Paulo, Brazil
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22
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Casey F, Van HMT, Donovan J, Nghia HDT, Oanh PKN, Thwaites CL, Phu NH, Thwaites GE. Automated pupillometry and optic nerve sheath diameter ultrasound to define tuberculous meningitis disease severity and prognosis. J Neurol Sci 2023; 453:120808. [PMID: 37722232 DOI: 10.1016/j.jns.2023.120808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Tuberculous meningitis (TBM) causes high mortality and morbidity, in part due to raised intracranial pressure (ICP). Automated pupillometry (NPi) and optic nerve sheath diameter (ONSD) are both low-cost, easy-to-use and non-invasive techniques that correlate with ICP and neurological status. However, it is uncertain how to apply these techniques in the management of TBM. METHODS We conducted a pilot study enrolling 20 adults with TBM in the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. Our objective was to investigate the relationships between baseline and serial measurements of NPi and ONSD and disease severity and outcome. Serial NPi and ONSD were performed for 30 days, at discharge, and at 3-months, with measurements correlated with clinical progression and outcomes. RESULTS ONSD and NPi measurements had an inverse relationship. Higher ONSD and lower NPi values were associated with lower Glasgow coma score. Baseline NPi was a strong predictor 3-month outcome (median NPi 4.55, interquartile range 4.35-4.65 for good outcomes versus 2.60, IQR 0.65-3.95 for poor outcomes, p = 0.002). Pupil inequality (NPi ≥0.7) was also strongly associated with poor 3-month outcomes (p = 0.006). Individual participants' serial NPi and ONSD were variable during initial treatment and correlated with clinical condition and outcome. CONCLUSION Pupillometry and ONSD may be used to predict clinical deterioration and outcome from TBM. Future, larger studies are need explore the optimal timing of measurements and to define how they might be used to optimise treatments and improve outcomes from TBM.
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Affiliation(s)
- Flora Casey
- London School of Hygiene and Tropical Medicine, Keppel St, London, UK.
| | - Hoang Minh Tu Van
- Northern Adelaide Local Health Network, South Australia, Australia; Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Joseph Donovan
- London School of Hygiene and Tropical Medicine, Keppel St, London, UK
| | - Ho Dang Trung Nghia
- Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam; Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
| | | | - C Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Nguyen Hoan Phu
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; School of Medicine, Vietnam National University of Ho Chi Minh City, Viet Nam
| | - Guy E Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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23
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Dias FA, Zotin MCZ, Alessio-Alves FF, Martins Filho RKDV, Barreira CMA, Vincenzi OC, Venturelli PM, Boulouis G, Goldstein JN, Pontes-Neto OM. Dilated optic nerve sheath by ultrasound predicts mortality among patients with acute intracerebral hemorrhage. Arq Neuropsiquiatr 2023; 81:861-867. [PMID: 37939718 PMCID: PMC10631847 DOI: 10.1055/s-0043-1775885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is a deadly disease and increased intracranial pressure (ICP) is associated with worse outcomes in this context. OBJECTIVE We evaluated whether dilated optic nerve sheath diameter (ONSD) depicted by optic nerve ultrasound (ONUS) at hospital admission has prognostic value as a predictor of mortality at 90 days. METHODS Prospective multicenter study of acute supratentorial primary ICH patients consecutively recruited from two tertiary stroke centers. Optic nerve ultrasound and cranial computed tomography (CT) scans were performed at hospital admission and blindly reviewed. The primary outcome was mortality at 90-days. Multivariate logistic regression, ROC curve, and C-statistics were used to identify independent predictors of mortality. RESULTS Between July 2014 and July 2016, 57 patients were evaluated. Among those, 13 were excluded and 44 were recruited into the trial. Their mean age was 62.3 ± 13.1 years and 12 (27.3%) were female. On univariate analysis, ICH volume on cranial CT scan, ICH ipsilateral ONSD, Glasgow coma scale, National Institute of Health Stroke Scale (NIHSS) and glucose on admission, and also diabetes mellitus and current nonsmoking were predictors of mortality. After multivariate analysis, ipsilateral ONSD (odds ratio [OR]: 6.24; 95% confidence interval [CI]: 1.18-33.01; p = 0.03) was an independent predictor of mortality, even after adjustment for other relevant prognostic factors. The best ipsilateral ONSD cutoff was 5.6mm (sensitivity 72% and specificity 83%) with an AUC of 0.71 (p = 0.02) for predicting mortality at 90 days. CONCLUSION Optic nerve ultrasound is a noninvasive, bedside, low-cost technique that can be used to identify increased ICP in acute supratentorial primary ICH patients. Among these patients, dilated ONSD is an independent predictor of mortality at 90 days.
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Affiliation(s)
- Francisco Antunes Dias
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Maria Clara Zanon Zotin
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Medicina Interna, Divisão de Radiologia, Ribeirão Preto SP, Brazil.
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States.
| | - Frederico Fernandes Alessio-Alves
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Rui Kleber do Vale Martins Filho
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Clara Monteiro Antunes Barreira
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Otavio Costa Vincenzi
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Paula Muñoz Venturelli
- Universidad del Desarrollo, Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina, Centro de Estudios Clínicos, Santiago, Chile.
| | - Gregoire Boulouis
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States.
| | | | - Octavio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
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24
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Xu X, Lu Y, Liu J, Xu R, Zhao K, Tao A. Diagnostic Value of the Combination of Ultrasonographic Optic Nerve Sheath Diameter and Width of Crural Cistern with Respect to the Intracranial Pressure in Patients Treated with Decompressive Craniotomy. Neurocrit Care 2023; 39:436-444. [PMID: 37037992 DOI: 10.1007/s12028-023-01711-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 02/28/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND The monitoring of intracranial pressure (ICP) and detection of increased ICP are crucial because such increases may cause secondary brain injury and a poor prognosis. Although numerous ultrasound parameters, including optic nerve sheath diameter (ONSD), width of the crural cistern (WCC), and the flow velocities of the central retinal artery and middle cerebral artery, can be measured in patients after hemicraniectomy, researchers have yet to determine which of these is better for evaluating ICP. This study aimed to analyze the correlation between ICP and ultrasound parameters and investigate the best noninvasive estimator of ICP. METHODS This observational study enrolled 50 patients with brain injury after hemicraniectomy from January 2021 to December 2021. All patients underwent invasive ICP monitoring with microsensor, transcranial, and ocular ultrasound postoperatively. We measured the ONSD including the dura mater (ONSDI), the ONSD excluding the dura mater, the optic nerve diameter (OND), the eyeball transverse diameter (ETD), the WCC, and the flow velocities in the central retinal artery and middle cerebral artery. Then, we calculated the ONSDI-OND (the difference between ONSDI and OND) and ONSDI/ETD (the ratio of ONSDI to ETD). Patients were divided into a normal ICP group (n = 35) and an increased ICP group (≥ 20 mm Hg, n = 15) according to the ICP measurements. Correlations were then assessed between the values of the ultrasound parameters and ICP. RESULTS The ONSDI, ONSDI-OND, and ONSDI/ETD were positively associated with ICP (r = 0.455, 0.482, 0.423 and p = 0.001, < 0.001, 0.002, respectively), whereas the WCC was negatively associated with ICP (r = - 0.586, p < 0.001). The WCC showed the highest predictive power for increased ICP (area under the receiver operating characteristic curve [AUC] = 0.904), whereas the ONSDI-OND and ONSDI also presented with acceptable predictive power among the ONSD-related parameters (AUC = 0.831, 0.803, respectively). The cutoff values for increased ICP prediction for ONSDI, ONSDI-OND, and WCC were 6.29, 3.03, and 3.68 mm, respectively. The AUC of the combination of ONSDI-OND and WCC was 0.952 (95% confidence interval 0.896-1.0, p < 0.001). CONCLUSIONS The ONSDI, ONSDI-OND, and WCC were correlated with ICP and had acceptable accuracy levels in estimating ICP in patients after hemicraniectomy. Furthermore, WCC showed a higher diagnostic value than ONSD-related parameters, and the combination of ONSDI-OND and WCC was a satisfactory predictor of increased ICP.
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Affiliation(s)
- Xiaolan Xu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Yajing Lu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Jiqiao Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Renfan Xu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Kai Zhao
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Anyu Tao
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
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25
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Monteiro A, Fritz AG, Cappuzzo JM, Waqas M, Levy EI, Siddiqui AH. Venous sinus stenting for the treatment of acute blindness in a patient with idiopathic intracranial hypertension. Interv Neuroradiol 2023; 29:605-608. [PMID: 35471853 PMCID: PMC10549719 DOI: 10.1177/15910199221095973] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 11/15/2022] Open
Abstract
We present a case of acute onset of blindness treated with venous sinus stenting in the hyperacute period (24-48 h). The patient had not been diagnosed previously with idiopathic intracranial hypertension and presented at an outside facility with a short history of headache, nausea, vomiting and visual deficits. Initial management included lumbar punctures for pressure relief. Unfortunately, the patient's condition deteriorated and she experienced the rapid onset of blindness. Within 24-48 h of blindness onset, she was transferred to our institution for emergent endovascular stenting of the venous sinuses. The intervention resulted in improvement of symptoms and recovery of visual acuity over a short-term follow-up period.
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Affiliation(s)
- Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Alexander G Fritz
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
- Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA
- Jacobs Institute, Buffalo, New York, USA
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26
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Bsteh G, Marik W, Macher S, Schmidbauer V, Krajnc N, Pruckner P, Mitsch C, Novak K, Wöber C, Pemp B. Impact of rater experience and referral question on detecting magnetic resonance imaging features of idiopathic intracranial hypertension. Eur J Neurol 2023; 30:3314-3321. [PMID: 37475659 DOI: 10.1111/ene.15986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/16/2023] [Accepted: 07/17/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND AND PURPOSE In idiopathic intracranial hypertension (IIH), magnetic resonance imaging (MRI) features are promising diagnostic markers, but the impact of rater experience and the specific referral question is unknown. METHODS From the Vienna Idiopathic Intracranial Hypertension database, patients were included with definitive IIH and routine cranial MRI performed during diagnostic work-up. Frequencies of partial empty sella (ES), optic nerve sheath distension (ONSD), optic nerve tortuosity (ONT), posterior globe flattening (PGF) and transverse sinus stenosis (TSS) were compared in three settings: (i) real-world rating, (ii) junior neuroradiologist without special IIH training and (iii) senior neuroradiologist with experience in IIH imaging (gold standard). RESULTS Magnetic resonance imaging scans of 84 IIH patients (88% female, mean age 33.5 years) were evaluated. By gold standard, ONSD was the most frequent (64.3%) followed by TSS (60.0%), ONT (46.4%), ES (44.4%) and PGF (23.8%). Compared to the gold standard, IIH features were described significantly less frequently in routine MRI reports (ONSD 28.6%, ONT 13.1%, PGF 4.8%, TSS 42.9%, p < 0.01 respectively) except for ES (42.9%, p = 0.9). A specific referral question regarding IIH increased detection rates in routine reports, but rates remained significantly lower than by gold standard. In contrast, a rating by a neuroradiologist without special training produced significantly higher frequencies of ONSD (81.0%, p < 0.01) and ONT (60.7%, p < 0.01) but not of ES (47.6%), PGF (29.8%) and TSS (68.1%). CONCLUSIONS Idiopathic intracranial hypertension MRI features are underestimated in routine MRI reports and partly overcalled by less experienced neuroradiologists, driven by features less well known or methodologically difficult. Reevaluation of MRI scans by an experienced rater (and to a lesser degree a specific referral question) improves diagnostic accuracy.
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Affiliation(s)
- Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Marik
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neuroradiology, Medical University of Vienna, Vienna, Austria
| | - Stefan Macher
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Victor Schmidbauer
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neuroradiology, Medical University of Vienna, Vienna, Austria
| | - Nik Krajnc
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Philip Pruckner
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Christoph Mitsch
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
| | - Klaus Novak
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
- Department of Neurosurgery, Medical University of Vienna, Vienna, Austria
| | - Christian Wöber
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Berthold Pemp
- Department of Ophthalmology, Medical University of Vienna, Vienna, Austria
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27
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Horev A, Ben-Arie G, Walter E, Tsumi E, Regev T, Aloni E, Biederko R, Zlotnik Y, Lebowitz Z, Shelef I, Honig A. Emergent cerebral venous stenting: A valid treatment option for fulminant idiopathic intracranial hypertension. J Neurol Sci 2023; 452:120761. [PMID: 37572407 DOI: 10.1016/j.jns.2023.120761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/04/2023] [Accepted: 07/31/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Fulminant idiopathic intracranial hypertension (FIIH) is characterized by rapid, severe, progressive vision loss and often treated surgically. Cerebral transverse venous stenting (CTVS) is efficacious in IIH patients, but emergent CTVS in FIIH is rarely reported. We present our experience with emergent CTVS in patients with FIIH. METHODS Since 01/2019, an institutional protocol allowed emergent CTVS in FIIH patients with bilateral transverse sinus stenosis and gradient pressure > 15 on digital subtraction angiography (DSA). We retrospectively analyzed a prospective registry of all IIH patients with details of neurological and neuro-ophthalmological assessments before and after treatment, and subjective assessments of headache and tinnitus were made pre-and post-procedure. RESULTS 259 IIH patients, including 49 who underwent CTVS, were registered. Among them, five female patients met inclusion criteria for FIIH and underwent emergent CTVS. FIIH patients were younger (18.8 ± 1.64 vs 27.7 ± 4.85, p < 0.01), mean BMI was lower (30.8 ± 10.57 vs 34.6 ± 4.3, p < 0.01), and lumbar puncture opening pressure higher (454 ± vs 361 ± 99.4, p < 0.01) than that of IIH patients. They presented with acute visual loss, severe headache, papilledema, significant bilateral transverse sinus stenosis on CT-venography, and mean dominant side gradient pressure of 26.4 ± 6.2 on DSA. CTVS was performed without significant complications, resulting in remarkable improvement in headache, optical coherence tomography, and visual fields within 1 week. At 1-year follow-up (four patients) and 6-month follow-up (1 patient), there was complete resolution of papilledema and headache, and marked improvement in visual acuity. CONCLUSIONS In these patients, emergent-CTVS was a safe and effective treatment option for FIIH. Further evaluation is warranted.
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Affiliation(s)
- Anat Horev
- Department of Neurology, Soroka Medical Center, Beer Sheva, Israel.
| | - Gal Ben-Arie
- Department of Radiology, Soroka Medical Center, Beer Sheva, Israel.
| | - Eyal Walter
- Department of Ophthalmology, Soroka Medical Center, Beer Sheva, Israel
| | - Erez Tsumi
- Department of Ophthalmology, Soroka Medical Center, Beer Sheva, Israel.
| | - Tamir Regev
- Department of Ophthalmology, Soroka Medical Center, Beer Sheva, Israel.
| | - Eyal Aloni
- Department of Ophthalmology, Barzilai Medical Center, Ashkelon, Israel
| | - Ron Biederko
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Yair Zlotnik
- Department of Neurology, Soroka Medical Center, Beer Sheva, Israel.
| | - Zachary Lebowitz
- Medical School for International Health, Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - Ilan Shelef
- Department of Radiology, Soroka Medical Center, Beer Sheva, Israel.
| | - Asaf Honig
- Department of Neurology, Soroka Medical Center, Beer Sheva, Israel.
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Montgomery SP, Moore B, Hampton SM, Macy G, Li W, Bronshteyn YS. Optic Nerve Sheath Point of Care Ultrasound: Image Acquisition. J Vis Exp 2023. [PMID: 37607087 DOI: 10.3791/64929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
The goal of this protocol is to develop a standardized method for acquiring images of the optic nerve sheath and measuring the optic nerve sheath diameter (ONSD). Diagnostic ultrasound of the ONSD to detect intracranial hypertension has traditionally faced many problems because of methodologic discrepancies. Due to inconsistencies in the measuring techniques, the potential for ONSD to become a non-invasive bedside monitoring tool for ICP has been hampered. However, establishing a transparent, consistent methodology for measuring the ONSD would support its use as a valid and reliable method of identifying intracranial hypertension. This is important as it has both high sensitivity and specificity in acute care settings. This narrative review describes ONSD POCUS image acquisition, including patient positioning, transducer selection, probe placement, the acquisition sequence, and image optimization. Further, visual aids are provided to assist in real-time during image acquisition. This method should be considered for patients for whom there are concerns regarding intracranial hypertension but who do not have an intracranial monitor in place.
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Affiliation(s)
| | - Brad Moore
- Medical Computing Group, Kitware Incorporated
| | | | - Gary Macy
- Division of Neurocritical Care, Duke University School of Medicine
| | - Weizhe Li
- Department of Neurology, Duke University School of Medicine
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Tilak AM, Yang LC, Morgan J, Peña-Garcia J, Thompson M, Burleson S, Atkins A, Sheehan D, Cho DY, Woodworth BA, Grayson JW. Optic nerve sheath diameter correlates to intracranial pressure in spontaneous CSF leak patients. Int Forum Allergy Rhinol 2023; 13:1518-1524. [PMID: 36541893 DOI: 10.1002/alr.23120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/21/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Spontaneous cerebrospinal fluid (sCSF) leaks develop from pressure erosion due to idiopathic intracranial hypertension, treatment of which is paramount to preventing recurrence. Direct measurements of intracranial pressure (ICP) for monitoring response to treatment via lumbar drain (LD) or ventriculostomy are invasive and have risks. The objectives of this study are to determine whether ultrasonographic measurements of optic nerve sheath diameter (ONSD) correlate with LD ICP in patients with sCSF leaks undergoing treatment, and whether ONSDs are larger in patients with sCSF leaks than controls. METHODS Subjects with sCSF leaks and controls were prospectively recruited. ONSD, sex, and body mass index (BMI) were analyzed. For sCSF leak subjects, ultrasonography was performed at the time of LD opening and each pressure check postoperatively, including the acetazolamide response. In control patients, measurements were obtained at the time of surgery. Pearson's correlation between ONSD and ICP was performed. RESULTS Subjects with sCSF leaks (n = 9, age 52.4 ± 9.5, all female) and controls (n = 8, age 60.1 ± 14.8, two females) had significantly different BMIs, 38.4 ± 8.1 vs. 29.2 ± 4.8, t(15) = 2.793, p = 0.014. ONSD was strongly correlated with ICP measurements (r = 0.583, p = 0.002). However, percentage change in ONSD and ICP measurements were more strongly correlated (r = 0.733, p < 0.001). Patients with sCSF leaks had significantly higher ONSDs than controls, 0.63 cm ± 0.044 vs. 0.56 cm ± 0.074, t(15) = 2.329, p = 0.034. CONCLUSION ONSD significantly correlated with ICP in sCSF leak patients and was wider in sCSF leak subjects than controls. Ultrasonography has utility in monitoring the ICP response to acetazolamide.
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Affiliation(s)
- Ashwini M Tilak
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lydia C Yang
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jake Morgan
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jaime Peña-Garcia
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maxwell Thompson
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, United States
| | - Samuel Burleson
- Department of Emergency Medicine, University of Alabama at Birmingham, Birmingham, United States
| | - Amanda Atkins
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Delaney Sheehan
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Do-Yeon Cho
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Otolaryngology Head and Neck Surgery, Veterans Medical Center, Birmingham, Alabama, USA
- Gregory Fleming Cystic Fibrosis Research Center, Birmingham, Alabama, USA
| | - Bradford A Woodworth
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Gregory Fleming Cystic Fibrosis Research Center, Birmingham, Alabama, USA
| | - Jessica W Grayson
- Department of Otolaryngology - Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Ma Z, Jiang H, Wang J. Enhancement of optic nerve sheath on MRI in idiopathic intracranial hypertension(IIH). Clin Neurol Neurosurg 2023; 231:107778. [PMID: 37348315 DOI: 10.1016/j.clineuro.2023.107778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/03/2023] [Accepted: 05/06/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE Optic nerve sheath(ONS) enhancement in idiopathic intracranial hypertension (IIH) patients has been reported in recent years. In this retrospective observation, we analyzed the clinical characteristics of IIH patients with enhancement of ONS. METHODS Eighty-two patients with clinically diagnosed IIH from January 2017 to December 2019 were under observation. Then, based on the presence of contrast-enhancement (CE) in ONS on orbital magnetic resonance image (MRI), the IIH patients were divided into CE-ONS group and no-CE(NCE)-ONS group. Six months follow-up information was also included in the observation study. By comparing clinical data of the two groups of IIH patients, we tried to evaluate whether there is clinical heterogeneity in CE-ONS patients. RESULT 12 patients were included in CE-ONS group, 10 females and 2 males. 70 patients were included in NCE-ONS group, 56 women and 14 men. We found that patients with CE-ONS had a longer course of disease (median disease duration before diagnosis, 5 months vs. 3months, P<0.01) and more likely had the sign of distension of the perioptic subarachnoid space (DPSS) (58.33 % vs. 24.29 %, P = 0.034). But no significant differences were found in demographic characteristics, clinical symptoms, degree of visual impairment, papilledema, opening pressure(OP) on lumbar puncture and clinical outcomes. CONCLUSION As a rare sign on MRI, ONS enhancement can occur in patients with IIH. IIH patients with CE-ONS may have a longer course of disease and more prone to DPSS, but there is no significant difference in clinical manifestations, OP, and clinical outcomes compared with IIH patients without CE-ONS.
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Affiliation(s)
- Zhonghua Ma
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Hanqiu Jiang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
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Gurav S, Zirpe K, Bhoyar A, Deshmukh A, Pote P, Kapse U, Tiwari A, Suryawanshi P, Malhotra R, Khan A, Dixit S. Utility of Bedside Ultrasound Measurement of Optic Nerve Sheath Diameter as a Screening Tool for raised Intracranial Pressure in Neurocritical Care Prospective Observational Study. J Assoc Physicians India 2023; 71:11-12. [PMID: 37449686 DOI: 10.59556/japi.71.0287] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Intracranial pressure (ICP) needs to be monitored in neurocritical patients. There is a need for portable bedside optic nerve ultrasound (ONUS) for early diagnosis to initiate the measures to reduce ICP Objective: To find the utility of bedside ONUS to diagnose raised ICP in neurocritical care. Materials and methods: After approval from the ethical committee, a prospective observational study was conducted. Optic nerve sheath diameter (ONSD) was measured in two groups: control group patients with neurological symptoms but computed tomography (CT)/magnetic resonance imaging (MRI) not suggestive of raised ICP, and second was study group patients with neurological symptoms and CT/MRI suggestive of elevated ICP Result: In patients with normal ICP, the mean ONSD in females was 4.47mm, and in males was 4.66mm. In patients with raised ICP, the mean ONSD in females was 6.45 ± 0.78 mm, and in males was 6.33 ± 0.70 mm. Regarding the correlation between Glasgow coma scale (GCS) and mean ONSD parameters, the coefficient of correlation (R) is 0.14; thus, there is a weak negative correlation. In our study, no difference was observed in raised mean ONSD in patients with different diagnoses. At a cut-off value of >4.8 mm, the sensitivity and specificity are 100% to diagnose raised ICP. Conclusion: Optic nerve sheath diameter (ONSD) is a reliable, rapid bedside screening tool in the Emergency Department/Critical Care/Operation Theatre to diagnose raised ICP. In order to keep a record of trends in ICP, we need to measure ONSD frequently. There was no correlation between GCS and ONSD measurement.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Ria Malhotra
- Junior Consultant, Department of Neurotrauma Unit
| | - Afroz Khan
- Consultant, Neurotrauma Unit, Ruby Hall Clinic
| | - Subhal Dixit
- Director, Department of Critical Care Unit, Sanjeevan Hospital, Pune, Maharashtra, India
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Kappagantu V, Sinha TP, Agrawal D, Jamshed N, Kumar A, Kumar A, Pandey RM, Gopinath B, Bhushan V, Tiwari AK, Bhoi SK. Diagnostic Accuracy of Ocular Ultrasonography in Identifying Raised Intracranial Pressure among Pediatric Population. Pediatr Neurosurg 2023; 58:142-149. [PMID: 37231881 DOI: 10.1159/000530921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/11/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Role of CT scan, MRI, ophthalmoscopy, direct monitoring by a transducer probe in identifying raised intracranial pressure (ICP) in emergency department is limited. There are few studies correlating elevated optic nerve sheath diameter (ONSD) measured by point of care ultrasound (POCUS) with raised ICP in pediatrics emergencies. We studied the diagnostic accuracy of ONSD, crescent sign, and optic disc elevation in identifying increased ICP in pediatrics. METHODS Prospective observational study was done between April 2018 and August 2019 after ethics approval. Out of 125 subjects, 40 patients without clinical features of raised ICP were recruited as external controls and 85 with clinical features of raised ICP as study subjects. Their demographic profile, clinical examination, and ocular ultrasound findings were noted. This was followed by CT scan. Out of 85 patients, 43 had raised ICP (cases) and 42 had normal ICP (disease controls). Diagnostic accuracy of ONSD in identifying raised ICP was evaluated using STATA. RESULTS The mean ONSD in case group was 5.5 ± 0.6 mm, 4.9 ± 0.5 mm in disease control group and external control group was 4.8 ± 0.3 mm. Cut-off of ONSD for raised ICP at ≥4.5 mm had a sensitivity and specificity of 97.67% and 10.98%, while ≥5.0 mm showed a sensitivity and specificity of 86.05% and 71.95%. Crescent sign and optic disc elevation had good correlation with increased ICP. CONCLUSION ONSD ≥5 mm by POCUS identified raised ICP in pediatric population. Crescent sign and optic disc elevation may function as additional POCUS signs in identifying raised ICP.
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Affiliation(s)
- Vignan Kappagantu
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tej Prakash Sinha
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Nayer Jamshed
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Atin Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Bharath Gopinath
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vidhya Bhushan
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Atul Kumar Tiwari
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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Kashkoush AI, Potter T, Petitt JC, Hu S, Hunter K, Kelly ML. Novel application of the Rotterdam CT score in the prediction of intracranial hypertension following severe traumatic brain injury. J Neurosurg 2023; 138:1050-1057. [PMID: 35962965 DOI: 10.3171/2022.6.jns212921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 06/17/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Severe traumatic brain injury (TBI) is associated with intracranial hypertension (ICHTN). The Rotterdam CT score (RS) can predict clinical outcomes following TBI, but the relationship between the RS and ICHTN is unknown. The purpose of this study was to investigate clinical and radiological factors that predict ICHTN in patients with severe TBI. METHODS The authors performed a single-center retrospective review of patients who, between 2018 and 2021, had an intracranial pressure (ICP) monitor placed following TBI. Radiological and clinical characteristics related to the TBI and ICP monitoring were collected. The main outcome of interest was ICHTN, which was a dichotomous outcome (yes or no) defined on a per-patient basis as an ICP > 22 mm Hg that persisted for at least 5 minutes and required an escalation of treatment. ICHTN included both elevated opening pressure on initial monitor placement and ICP elevations later during hospitalization. Multivariate logistic regression was performed to determine variables associated with ICHTN. Diagnostic accuracy was evaluated using the area under the receiver operating characteristic curve (AUROC). RESULTS Seventy patients with severe TBI and an ICP monitor were included in this study. There was a predominance of male patients (94.0%), and the mean patient age was 40 years old. Most patients (67%) had an intraparenchymal catheter placed, whereas 33% of patients had a ventriculostomy catheter placed. In the multivariate logistic regression analysis, the RS was an independent predictor of ICHTN (OR 2.0, 95% CI 1.2-3.5, p = 0.014). No instances of ICHTN were observed in patients with an RS of 2 or less and no sulcal effacement. The AUROC of the RS and sulcal effacement was higher than the AUROC of the RS alone for predicting ICHTN (0.76 vs 0.71, p = 0.003, z-test). CONCLUSIONS The RS was predictive of ICHTN in patients with severe TBI, and the diagnostic accuracy of the model was improved with the inclusion of sulcal effacement at the vertex on CT of the head. Patients with a low RS and no sulcal effacement are likely at low risk for the development of ICHTN.
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Affiliation(s)
| | - Tamia Potter
- 2Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland; and
| | - Jordan C Petitt
- 2Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland; and
| | - Song Hu
- 3Department of Radiology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio
| | - Kyle Hunter
- 3Department of Radiology, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio
| | - Michael L Kelly
- 2Department of Neurological Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland; and
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Schmidt B, Czosnyka M, Cardim D, Czosnyka Z, Rosengarten B. Is Lumbar Puncture Needed? - Noninvasive Assessment of ICP Facilitates Decision Making in Patients with Suspected Idiopathic Intracranial Hypertension. Ultraschall Med 2023; 44:e91-e98. [PMID: 34496407 PMCID: PMC10063336 DOI: 10.1055/a-1586-6487] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Idiopathic intracranial hypertension (IIH) usually occurs in obese women of childbearing age. Typical symptoms are headache and sight impairment. Lumbar puncture (LP) is routinely used for both diagnosis and therapy (via cerebrospinal fluid drainage) of IIH. In this study, noninvasively assessed intracranial pressure (nICP) was compared to LP pressure (LPP) in order to clarify its feasibility for the diagnosis of IIH. MATERIALS AND METHODS nICP was calculated using continuous signals of arterial blood pressure and cerebral blood flow velocity in the middle cerebral artery, a method which has been introduced recently. In 26 patients (f = 24, m = 2; age: 33 ± 11 years), nICP was assessed one hour prior to LPP. If LPP was > 20 cmH2O, lumbar drainage was performed, LPP was measured again, and also nICP was reassessed. RESULTS In total, LPP and nICP correlated with R = 0.85 (p < 0.001; N = 38). The mean difference of nICP-LPP was 0.45 ± 4.93 cmH2O. The capability of nICP to diagnose increased LPP (LPP > 20 cmH2O) was assessed by ROC analysis. The optimal cutoff for nICP was close to 20 cmH2O with both a sensitivity and specificity of 0.92. Presuming 20 cmH2O as a critical threshold for the indication of lumbar drainage, the clinical implications would coincide in both methods in 35 of 38 cases. CONCLUSION The TCD-based nICP assessment seems to be suitable for a pre-diagnosis of increased LPP and might eliminated the need for painful lumbar puncture if low nICP is detected.
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Affiliation(s)
| | - Marek Czosnyka
- Brain Physics Laboratory, Clinical Neurosciences, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
| | - Danilo Cardim
- Neurology, The University of Texas Southwestern Medical Center, Dallas, United States
| | - Zofia Czosnyka
- Brain Physics Laboratory, Clinical Neurosciences, University of Cambridge, United Kingdom of Great Britain and Northern Ireland
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Wang Z, Dandu C, Guo Y, Gao M, Lan D, Pan L, Zhou D, Ding Y, Ji X, Meng R. A novel score to estimate thrombus burden and predict intracranial hypertension in cerebral venous sinus thrombosis. J Headache Pain 2023; 24:29. [PMID: 36932331 PMCID: PMC10022088 DOI: 10.1186/s10194-023-01562-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/07/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Current methods to evaluate the severity of cerebral venous sinus thrombosis (CVST) lack patient-specific indexes. Herein, a novel scoring method was investigated to estimate the thrombus burden and the intracranial pressure (ICP) of CVST. METHODS In this retrospective study from January 2019 through December 2021, we consecutively enrolled patients with a first-time confirmed diagnosis of CVST by contrast-enhanced magnetic resonance venography (CE-MRV) or computed tomography venography (CTV). In these patients, a comprehensive CVST-Score was established using magnetic resonance black-blood thrombus imaging (MRBTI) to estimate the thrombus burden semi-quantitatively. The relationship between CVST-Score and ICP was explored to assess the potential of using the CVST-score to evaluate ICP noninvasively and dynamically. RESULTS A total of 87 patients were included in the final analysis. The CVST-Scores in different ICP subgroups were as follows: 4.29±2.87 in ICP<250mmH2O subgroup, 11.36±3.86 in ICP =250-330mmH2O subgroup and 14.99±3.15 in ICP>330mmH2O subgroup, respectively (p<0.001). For patients with ICP ≤330mmH2O, the CVST-Score was linearly and positively correlated with ICP (R2=0.53). The receiver operating characteristic (ROC) curves showed the optimal CVST-Score cut-off values to predict ICP ≥250mmH2O and >330mmH2O were 7.15 and 11.62, respectively (P<0.001). Multivariate analysis indicated CVST-Score as an independent predictor of ICP ≥250mmH2O (odds ratio, 2.15; 95% confidence interval, 1.49-3.10; p<0.001). CONCLUSIONS A simple and noninvasive CVST-Score can rapidly estimate the thrombus burden and predict the severity of intracranial hypertension in patients with CVST. The CVST-Score can aid in evaluating therapeutic responses and avoiding unnecessary invasive procedures at long-term follow-up.
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Affiliation(s)
- Zhongao Wang
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Chaitu Dandu
- grid.254444.70000 0001 1456 7807Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan 48201 USA
| | - Yibing Guo
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Meini Gao
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Duo Lan
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Liqun Pan
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Da Zhou
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
| | - Yuchuan Ding
- grid.254444.70000 0001 1456 7807Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan 48201 USA
| | - Xunming Ji
- grid.413259.80000 0004 0632 3337Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
| | - Ran Meng
- grid.413259.80000 0004 0632 3337Department of Neurology, National Center for Neurological Disorders, Xuanwu Hospital, Capital Medical University, Beijing, 100053 China
- grid.24696.3f0000 0004 0369 153XAdvanced Center of Stroke, Beijing Institute for Brain Disorders, Beijing, 100053 China
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Li Y, Zhang G, Shan Y, Wu X, Liu J, Xue Y, Gao G. Non-Invasive Assessment of Intracranial Hypertension in Patients with Traumatic Brain Injury Using Computed Tomography Radiomic Features: A Pilot Study. J Neurotrauma 2023; 40:250-259. [PMID: 36097763 PMCID: PMC9902045 DOI: 10.1089/neu.2022.0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
This study aimed to assess intracranial hypertension in patients with traumatic brain injury non-invasively using computed tomography (CT) radiomic features. Fifty patients from the primary cohort were enrolled in this study. The clinical data, pre-operative cranial CT images, and initial intracranial pressure readings were collected and used to develop a prediction model. Data of 20 patients from another hospital were used to validate the model. Clinical features including age, sex, midline shift, basilar cistern status, and ventriculocranial ratio were measured. Radiomic features-i.e., 18 first-order and 40 second-order features- were extracted from the CT images. LASSO method was used for features filtration. Multi-variate logistic regression was used to develop three prediction models with clinical (CF model), first-order (FO model), and second-order features (SO model). The SO model achieved the most robust ability to predict intracranial hypertension. Internal validation showed that the C-statistic of the model was 0.811 (95% confidence interval [CI]: 0.691-0.931) with the bootstrapping method. The Hosmer Lemeshow test and calibration curve also showed that the SO model had excellent performance. The external validation results showed a good discrimination with an area under the curve of 0.725 (95% CI: 0.500-0.951). Although the FO model was inferior to the SO model, it had better prediction ability than the CF model. The study shows that the radiomic features analysis, especially second-order features, can be used to evaluate intracranial hypertension non-invasively compared with conventional clinical features, given its potential for clinical practice and further research.
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Affiliation(s)
- Yihua Li
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoqing Zhang
- Department of Neurosurgery, the People's Hospital of Qiannan, Guizhou, China
| | - Yingchi Shan
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang Wu
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaqi Liu
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yajun Xue
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoyi Gao
- Department of Neurosurgery, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Abstract
PURPOSE OF REVIEW Idiopathic intracranial hypertension (IIH) is a disorder of raised intracranial pressure (ICP). Although the majority of patients with IIH present classically with headache and papilledema, some patients may have unusual presentations or manifestations. Recent advancements in neuroimaging have facilitated the identification of other presentations associated with IIH. This review provides an overview of the expanding clinical spectrum of IIH. RECENT FINDINGS Presentations of IIH that are considered unusual include highly asymmetric or unilateral papilledema, IIH without papilledema, and IIH associated with cranial nerve involvement. These presentations likely reflect differences in the way cerebrospinal fluid (CSF) pressure is transmitted intracranially. Radiological signs of intracranial hypertension are increasingly recognized in patients with IIH and provide further insights into the effects of raised ICP on intracranial structures. Osseous changes in the skull base leading to formation of meningoceles and encephaloceles have been identified in patients with IIH, spontaneous skull base CSF leak, and drug-resistant temporal lobe epilepsy, suggesting a possible association. SUMMARY Clinicians should be familiar with the expanding clinical spectrum of IIH and the implications for the management of these presentations.
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Affiliation(s)
- Benson S. Chen
- John van Geest Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge
- Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
| | - John O.T. Britton
- John van Geest Centre for Brain Repair and MRC Mitochondrial Biology Unit, Department of Clinical Neurosciences, University of Cambridge
- Cambridge Eye Unit, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, United Kingdom
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Şık N, Öztürk A, Yılmaz D, Duman M. The Role of Ultrasound in Pediatric Skull Fractures: Determination of Fracture and Optic Nerve Sheath Diameter Measurements. Pediatr Emerg Care 2023; 39:91-97. [PMID: 36719390 DOI: 10.1097/pec.0000000000002895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim of the present study was to determine the accuracy of point-of-care ultrasound (POCUS) for detecting skull fractures and to evaluate sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball vertical diameter (EVD) ratios in children with head trauma. METHODS Children who presented with local signs of head trauma and underwent cranial computed tomography (CT) were enrolled. The suspected area was examined by POCUS to identify a skull fracture, and then the ONSD at 3 mm posterior to the globe and the EVD were measured. Ratios of ONSD measurement at 3 mm/EVD were reported. All ONSD measurements and ratios were calculated from cranial CT images. RESULTS There were 112 children enrolled in the study. The sensitivity and specificity of POCUS for skull fractures was 93.7% (95% confidence interval [CI], 82.8-98.6) and 96.8% (95% CI, 89.1-99.6), whereas the positive predictive value was 95.7% (95% CI, 85.1-98.8), and the negative predictive value was 95.3% (95% CI, 87.3-98.4). There was high agreement between POCUS and CT for identifying skull fractures (κ, 0.90 [±0.04]). In the group without elevated intracranial pressure findings on CT, patients with space-occupying lesions (SOLs) had higher sonographic ONSD measurements and ratios (P < 0.001) compared with cases without SOLs. CONCLUSIONS When used with clinical decision rules to minimize the risk for clinically important traumatic brain injury, POCUS seems to be a promising tool to detect skull fractures and calculate ONSD measurements and rates to predict the risk for SOLs and perform further risk stratification of children with minor head trauma.
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Affiliation(s)
- Nihan Şık
- From the Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
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Asnafi S, Chen BS, Biousse V, Newman NJ, Saindane AM. Intracranial computed tomography histogram analysis detects changes in the setting of elevated intracranial pressure and normal imaging. Neuroradiol J 2022; 35:718-723. [PMID: 35506947 PMCID: PMC9626849 DOI: 10.1177/19714009221096832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Patients with idiopathic intracranial hypertension (IIH) have elevated intracranial pressure (ICP) of unclear etiology. This study evaluated the ability of quantitative intracranial Hounsfield unit (HU) histogram analysis to detect pathophysiological changes from elevated ICP in the setting of a normal head CT. METHODS Retrospective analysis of non-contrast-enhanced head CT images of IIH patients and matched controls. Following skull stripping, total intracranial CT voxels within the range of 0-70 HU were divided into seven 10 HU bins. A measurement of total intracranial HU was also calculated for each patient. Imaging studies for IIH patients were reviewed for features of IIH including transverse sinus stenosis (TSS). Histogram measures were compared between IIH and control groups and correlated with imaging and clinical data. RESULTS Fourteen IIH patients with CSF opening pressure ≥25 cm water, and 31 age-, sex-, and ethnicity-matched controls were included. Compared to controls, IIH patients had a significantly greater proportion of voxels in the 40-50, 50-60, and 60-70 HU bins (p = 0.003, 0.001, and 0.003, respectively) but similar proportion in the 0-10 HU range. Severity of TSS significantly correlated with total intracranial HU measures. 50-60 HU and 60-70 HU bins demonstrated high AUCs of 0.81 and 0.80, respectively, in differentiating IIH from normal status. CONCLUSION Idiopathic intracranial hypertension patients have a greater proportion of high intracranial HU voxels representing blood volume, which may be explained by TSS causing venous congestion. The pattern provides further insights into the pathophysiology of IIH and may be useful for detecting elevated ICP in the setting of normal head CT imaging.
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Affiliation(s)
- Solmaz Asnafi
- Department of Radiology and Imaging
Sciences, Emory University School of
Medicine, Atlanta, GA, USA
| | - Benson S Chen
- Department of Ophthalmology, Emory University School of
Medicine, Atlanta, GA, USA
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of
Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of
Medicine, Atlanta, GA, USA
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of
Medicine, Atlanta, GA, USA
- Department of Neurology, Emory University School of
Medicine, Atlanta, GA, USA
- Department of Neurological Surgery, Emory University School of
Medicine, Atlanta, GA, USA
| | - Amit M Saindane
- Department of Radiology and Imaging
Sciences, Emory University School of
Medicine, Atlanta, GA, USA
- Department of Neurological Surgery, Emory University School of
Medicine, Atlanta, GA, USA
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Şık N, Ulusoy E, Çitlenbik H, Öztürk A, Er A, Yılmaz D, Duman M. The role of sonographic optic nerve sheath diameter measurements in pediatric head trauma. J Ultrasound 2022; 25:957-963. [PMID: 35396696 PMCID: PMC9705618 DOI: 10.1007/s40477-022-00676-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To determine the accuracy of bedside sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse (ETD) diameter ratios to predict space-occupying lesions (SOLs) or elevated intracranial pressure (ICP) in pediatric head trauma. METHODS Children who presented to the emergency department with head trauma and underwent cranial computed tomography (CT) were enrolled and examined by ocular ultrasonography (US), and the ONSD was measured at 3 mm posterior to the globe and ETD were measured. Ratios of ONSD at 3 mm/ETD were calculated. All ONSD measurements and ratios were calculated from cranial CT images. RESULTS Subjects with elevated ICP had increased ONSD measurements and ratios. To predict elevated ICP, the AUC for ONSD at 3 mm was 0.956 (95% CI 0.896-1). At a cut-off level of 5.1 mm, the sensitivity and specificity of ONSD 3 mm values for elevated ICP were 92.9% and 94.0%. For the ONSD 3 mm/ETD ratio, it was 0.980 (95% CI 0.959-1). At a cut-off level of 0.22, the sensitivity and specificity were 100% sensitivity and 88.0%. All sonographic ONSD measurements and ratios were significantly correlated with readings calculated from cranial CT images. CONCLUSION Sonographic ONSD measurements and ratios were found to be quite sensitive to detect elevated ICP on cranial CT images. Additionally, there was a significant correlation between measurements calculated by ocular US and cranial CT scans. Bedside ocular US seems to be a promising and useful tool to determine ICP in children with head trauma.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Emel Ulusoy
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Hale Çitlenbik
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Ali Öztürk
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Anıl Er
- Division of Pediatric Emergency Care, Department of Pediatrics, Dr. Behçet Uz Children's Hospital, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey.
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张 涛, 刘 春. [Clinical value of bedside transcranial doppler ultrasound in assessing intracranial pressure in critically ill pediatric patients with nervous system disease]. Zhongguo Dang Dai Er Ke Za Zhi 2022; 24:973-978. [PMID: 36111713 PMCID: PMC9495246 DOI: 10.7499/j.issn.1008-8830.2203081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To study the value of bedside transcranial doppler (TCD) in evaluating the level of intracranial pressure (ICP) in critically ill pediatric patients with nervous system disease in the pediatric intensive care unit (PICU). METHODS A prospective analysis was performed on the critically ill pediatric patients with nervous system disease who were admitted to the PICU of Shengjing Hospital, China Medical University, from November 2020 to November 2021. Bedside TCD was performed on all patients, and pulsatility index (PI) was calculated. Bedside lumbar puncture was performed to measure ICP. A Pearson correlation analysis was used to assess the correlation between PI and ICP. The receiver operating characteristic (ROC) curve was used to assess the value of PI in the diagnosis of elevated ICP (≥20 mm Hg). RESULTS A total of 56 children were included in the study. The top three primary diseases were intracranial infection (24 children, 43%), traumatic brain injury (TBI) (11 children, 20%), and cerebrovascular disease (5 children, 9%). The Pearson correlation analysis showed that PI was positively correlated with ICP (r=0.536, P<0.001). The subgroup analysis based on primary disease showed that in the TBI group, PI was positively correlated with ICP (r=0.655, P=0.029), while no significant correlation between PI and ICP was observed in the intracranial infection group (r=0.324, P=0.122). The ROC curve analysis showed that PI had an area under the curve of 0.828 (95%CI: 0.677-0.979) in predicting ICP≥20 mm Hg, with a sensitivity of 83.3% and a specificity of 79.5% at the optimal cut-off value of 1.255. CONCLUSIONS TCD technology for ICP monitoring can predict the change in ICP in critically ill pediatric patients with nervous system disease, suggesting it is useful for treatment options and prognosis evaluation.
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Çankaya I, Bayar Muluk N, Burulday V, Karadeniz Bilgili MY, Özdemir A. Noticable Findings in Cranial MRI of the Patients with Idiopathic Intracranial Hypertension. Am J Rhinol Allergy 2022; 36:415-422. [PMID: 35234081 DOI: 10.1177/19458924211069213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure. We investigated the optic nerve, Meckel's cavity, internal carotid artery (ICA) and pituitary findings of IIH by Cranial Magnetic Resonance Imaging (MRI). METHODS Cranial MRI images of 35 adult patients with IIH and 35 adult subjects with normal cranial MRI results (control) were evaluated. Optic nerve diameter (OND), optic nerve sheat diameter (ONSD), OND/ONSD ratio, ON tortuosity, ON protrusion, posterior scleral flattening, ICA transverse diameter, CSF distance in Meckel's cavity and ICA transverse diameter/CSF distance in Meckel's cavity ratio, and pituitary gland measurements (height and transverse dimension; and Optic chiasm- pituitary gland distance) were measured. RESULTS OND and ONSD of the IIH group were significantly higher than those of the control groups at anterior and posterior measurements (p < 0.05). OND/ONSD ratio of the IIH group was lower at anterior measurement; and higher at the posterior measurement than the control group (p < 0.05). Right ICA transverse diameter and bilateral CSF distance in Meckel's cavity of the IIH group were higher than those of the control. Optic chiasm- pituitary gland distance of the IIH group was significantly higher than that of the control group (p < 0.05). CONCLUSION OND/ONSD ratio is different in anterior and posterior measurements. So we recommend measuring OND and ONSD separately in IIH patients to use in the clinical practice. Similarly, optic chiasm-pituitary gland distance is also another point to note for IIH patients on MRI. Our paper adds new approach to IIH in terms of OND/ONSD ratio.
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Affiliation(s)
- Imran Çankaya
- Faculty of Medicine, Radiology Department, Kırıkkale University, Kırıkkale, Turkey
| | - Nuray Bayar Muluk
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
| | - Veysel Burulday
- Faculty of Medicine, Radiology Department, Inönü University, Malatya, Turkey
| | | | - Adnan Özdemir
- Faculty of Medicine, Radiology Department, Kırıkkale University, Kırıkkale, Turkey
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Senol O, Cosgun Z, Dagistan E, Demiryurek BE, Cancan SE. Role of the optic nerve sheath diameter in the assessment of the effectiveness of decompressive surgery after malignant middle cerebral artery infarction. Arq Neuropsiquiatr 2022; 80:671-675. [PMID: 36254438 PMCID: PMC9685816 DOI: 10.1055/s-0042-1754345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND After a case of stroke, intracranial pressure (ICP) must be measured and monitored, and the gold standard method for that is through an invasive technique using an intraventricular or intraparenchymal device. However, The ICP can also be assessed through a non-invasive method, comprised of the measurement of the optic nerve sheath diameter (ONSD) through ultrasound (US). OBJECTIVE To evaluate the ICP of patients who underwent wide decompressive craniectomy after middle cerebral artery (MCA) infarction via preoperative and postoperative ONSD measurements. METHODS A total of 17 patients, aged between 34 and 70 years, diagnosed with malignant MCA infarction with radiological edema and mid-line shift, who underwent decompressive surgery, were eligible. From the records, we collected data on age, sex, preoperative and postoperative Glasgow Coma Scale (GCS) scores, National Institutes of Health Stroke Scale (NIHSS) score, the degree of disability in the preoperative period and three months postoperatively through the scores on the Modified Rankin Scale (MRS), and the preoperative and postoperative midline shift measured by computed tomography (CT) scans of the brain. RESULTS Preoperatively, the mean GCS score was of 8 (range: 7.7-9.2), whereas it was found to be of 12 (range 10-14) on the first postoperative day (p = 0.001). The mean preoperative NIHSS score was of 21.36 ± 2.70 and, on the first postoperative day, it was of 5.30 ± 0.75 (p < 0.001). As for the midline shift, the mean preoperative value was of 1.33 ± 0.75 cm, and, on the first postoperative day, 0.36 ± 0.40 cm (p < 0.001). And, regarding the ONSD, the mean preoperative measurement was of 5.5 ± 0.1 mm, and, on the first postoperative day, it was of 5 ± 0.9 mm (p < 0.001). CONCLUSION The ocular US measurement of the ONSD for the preoperative and postoperative monitoring of the ICP seems to be a practical and useful method.
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Affiliation(s)
- Ozgur Senol
- Bolu Abant Izzet Baysal University, Faculty of Medicine, Department of Neurosurgery, Bolu, Turkey
| | - Zeliha Cosgun
- Bolu Abant Izzet Baysal University, Faculty of Medicine, Department of Radiology, Bolu, Turkey
| | - Emine Dagistan
- Bolu Abant Izzet Baysal University, Faculty of Medicine, Department of Radiology, Bolu, Turkey
| | - Bekir Enes Demiryurek
- Bolu Abant Izzet Baysal University, Faculty of Medicine, Department of Neurology, Bolu, Turkey
| | - Seckin Emre Cancan
- Bolu Abant Izzet Baysal University, Faculty of Medicine, Department of Neurosurgery, Bolu, Turkey
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Robba C. Measuring optic nerve sheath diameter using ultrasonography for the detection of non invasive intracranial pressure: what it is and what it is not. Arq Neuropsiquiatr 2022; 80:547-549. [PMID: 35946717 PMCID: PMC9387181 DOI: 10.1590/0004-282x-anp-2022-e006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Chiara Robba
- San Martino Policlinico Hospital, Anesthesia and Critical Care, IRCCS for Oncology and Neuroscience, Genoa, Italy
- University of Genoa, Department of Surgical Sciences and Integrated Diagnostics, Genoa, Italy
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Xu G, Wu X, Yu J, Ding H, Ni Z, Wang Y. Non-invasive intracranial pressure assessment using shear-wave elastography in neuro-critical care patients. J Clin Neurosci 2022; 99:261-267. [PMID: 35306456 DOI: 10.1016/j.jocn.2022.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/24/2022] [Accepted: 03/05/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To determine if Young's modulus of the optic nerve (ON) structure as measured by shear-wave elastography can suggest changes in intracranial pressure (ICP) in neuro-critical care patients. MATERIALS AND METHODS Thirty-one healthy volunteers and twenty-two neuro-critical care patients were enrolled. ON sheath (ONS) diameter (ONSD) values and Young's modulus measurements of volunteers were collected in a calm state and during a Valsalva maneuver (VM). Ultrasound measurements and ICP values of patients were collected on operation day and at 24 and 48 h after the operation; measurements were thereafter assigned to three groups: severely elevated (ICP greater than 22 mmHg), mildly elevated (ICP = 14-22 mmHg), and normal (ICP ≤ 13 mmHg). RESULTS ONSD and Young's modulus for the ON and ONS of volunteers during VM were higher than those in the calm state (all P < 0.001). In contrast to ONSD, Young's modulus for ON and ONS did not correlate with age, body mass index, or sex. The best cutoff values of Young's modulus for ON for predicting elevated and severely elevated ICP were 16.67 kPa and 22.74 kPa, respectively. Accordingly, the sensitivity values were 96.7% and 88.9%, and the specificity values were 86.1% and 73.7%, which had the same diagnostic performance as ONSD. CONCLUSION Young's modulus of the ON accurately reflects changes in ICP. It is not confounded by age, sex, or body mass index compared to ONSD.
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Affiliation(s)
- Guohui Xu
- Department of Ultrasonic Medicine, Fudan University Affiliated Huashan Hospital, No 12, Middle Wulumuqi Road, Shanghai 200040, China
| | - Xuehai Wu
- Department of Neurosugery, Fudan University Affiliated Huashan Hospital, No 12, Middle Wulumuqi Road, Shanghai 200040, China
| | - Jian Yu
- Department of Neurosugery, Fudan University Affiliated Huashan Hospital, No 12, Middle Wulumuqi Road, Shanghai 200040, China
| | - Hong Ding
- Department of Ultrasonic Medicine, Fudan University Affiliated Huashan Hospital, No 12, Middle Wulumuqi Road, Shanghai 200040, China
| | - Zilong Ni
- Department of Ultrasound Clinical Market, Simens Healthineers, No 399, West Haiyang Road, Shanghai 200126, China
| | - Yong Wang
- Department of Ultrasonic Medicine, Fudan University Affiliated Huashan Hospital, No 12, Middle Wulumuqi Road, Shanghai 200040, China.
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Sharma B, Seervi N, Sharma V, Panagariya A, Goel D. Clinical and Radiological Profile of 122 Cases of Idiopathic Intracranial Hypertension in a Tertiary Care Centre of India: An Observational Study. Neurol India 2022; 70:704-709. [PMID: 35532643 DOI: 10.4103/0028-3886.344644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is well-described entity in literature. However, large studies on clinical and radiological profile are still very few from the Indian subcontinent. AIMS To analyze the clinical and radiological profile of IIH and correlation of various clinical and radiological parameters with papilledema and CSF opening pressure. SETTING AND DESIGN Hospital-based observational, descriptive study. MATERIALS AND METHODS This study analyzed 122 patients admitted in the department of Neurology (from January 2014 to December 2018) for detailed history, clinical examination, and neuroimaging. CSF manometry and routine CSF analysis were done. All participants met the modified Dandy criteria. Patients with secondary causes of raised ICP and primary ocular pathology were excluded. STATISTICAL ANALYSIS USED Descriptive statistics and Chi-square test. RESULTS Among 122 cases 86 (70.49%) were females. The mean age was 33 years. 62 (50.82%) cases were obese. Headache was the most common symptom (114/122; 93.44%). Bilateral papilledema was noted in 114 (93.44%) cases. Higher grades of papilledema had a correlation with higher CSF opening pressure. Empty sella was the most common radiological finding (100/122; 81.97%). All radiological findings except empty sella had a correlation with higher CSF opening pressure. CONCLUSION IIH typically affects obese females of childbearing age group. However, it is not uncommon in the nonobese and male sex. Obesity may not be a dominant risk factor for the development of IIH in the Indian subcontinent. Cases with normal BMI and male sex with clinical features of raised intracranial pressure and normal neuroimaging should also be evaluated for IIH. Cases with refractory headache and empty sella on MRI should be evaluated for IIH.
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Affiliation(s)
- Bhawna Sharma
- Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India
| | - Naveen Seervi
- Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India
| | - Vikas Sharma
- Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India
| | - Ashok Panagariya
- Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India
| | - Divya Goel
- Department of Neurology, SMS Medical College, Jaipur, Rajasthan, India
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Aletreby W, Alharthy A, Brindley PG, Kutsogiannis DJ, Faqihi F, Alzayer W, Balhahmar A, Soliman I, Hamido H, Alqahtani SA, Karakitsos D, Blaivas M. Optic Nerve Sheath Diameter Ultrasound for Raised Intracranial Pressure: A Literature Review and Meta-analysis of its Diagnostic Accuracy. J Ultrasound Med 2022; 41:585-595. [PMID: 33893746 DOI: 10.1002/jum.15732] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Revised: 01/31/2021] [Accepted: 03/07/2021] [Indexed: 06/12/2023]
Abstract
UNLABELLED Optic nerve sheath diameter (ONSD) ultrasound is becoming increasingly more popular for estimating raised intracranial pressure (ICP). We performed a systematic review and analysis of the diagnostic accuracy of ONSD when compared to the standard invasive ICP measurement. METHOD We performed a systematic search of PUBMED and EMBASE for studies including adult patients with suspected elevated ICP and comparing sonographic ONSD measurement to a standard invasive method. Quality of studies was assessed using the QUADAS-2 tool by two independent authors. We used a bivariate model of random effects to summarize pooled sensitivity, specificity, and diagnostic odds ratio (DOR). Heterogeneity was investigated by meta-regression and sub-group analyses. RESULTS We included 18 prospective studies (16 studies including 619 patients for primary outcome). Only one study was of low quality, and there was no apparent publication bias. Pooled sensitivity was 0.9 [95% confidence intervals (CI): 0.85-0.94], specificity was 0.85 (95% CI: 0.8-0.89), and DOR was 46.7 (95% CI: 26.2-83.2) with partial evidence of heterogeneity. The Area-Under-the-Curve of the summary Receiver-Operator-Curve was 0.93 (95% CI: 0.91-0.95, P < .05). No covariates were significant in the meta-regression. Subgroup analysis of severe traumatic brain injury and parenchymal ICP found no heterogeneity. ICP and ONSD had a correlation coefficient of 0.7 (95% CI: 0.63-0.76, P < .05). CONCLUSION ONSD is a useful adjunct in ICP evaluation but is currently not a replacement for invasive methods where they are feasible.
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Affiliation(s)
- Waleed Aletreby
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Alharthy
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Neurocritical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Peter G Brindley
- Critical Care Department, The University of Alberta, School of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Demetrios J Kutsogiannis
- Critical Care Department, The University of Alberta, School of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Fahad Faqihi
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Neurocritical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Waseem Alzayer
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Neurocritical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | | | - Ibrahim Soliman
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Neurocritical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Hend Hamido
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Saleh A Alqahtani
- Department of Medicine, The Johns Hopkins University Hospital, Baltimore, Maryland, USA
| | - Dimitrios Karakitsos
- Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Neurocritical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
- Department of Internal Medicine, University of South Carolina, School of Medicine, Columbia, South Carolina, USA
- Critical Care Department, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael Blaivas
- Department of Internal Medicine, University of South Carolina, School of Medicine, Columbia, South Carolina, USA
- Department of Emergency Medicine, St. Francis Hospital, Columbus, Georgia, USA
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Doğan GM, Siğirci A, Okut G, Cicek E, Dogan SM, Yilmaz S, Arslan AK. The magnetic resonance imaging assessment of optic nerve sheath diameter in pediatric acute liver failure patients. Eur Rev Med Pharmacol Sci 2022; 26:853-859. [PMID: 35179751 DOI: 10.26355/eurrev_202202_27993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the diagnostic value of optic nerve sheath diameter (ONSD) using brain MRI in the pretransplantation period in the pediatric acute liver failure patients, and correlate the ONSD with clinical grade of hepatic encephalopathy (HE) and MRI findings. PATIENTS AND METHODS Forty acute liver failure patients and 40 control group patients were retrospectively analyzed. The high signal intensities in T2W (T2-weighted image), FLAIR (Fluid Attenuated Inversion Recovery) and DWI (diffusion-weighted imaging) sequences were evaluated and ONSD was measured. The patients were grouped first into 5 according to their West Haven score, and HE grade 0 and grade 1 were accepted as low grade HE, HE grade 2, 3 and 4 were accepted as high grade HE. The patients were grouped to 2 according to the MRI findings as low grade and high grade MRI group. RESULTS The mean value of ONSD was 6.0 ± 1.80 and 4.94 ± 1.27 in the all patients and in the control group, respectively. There was statistically significant difference between both the ONSD and the low grade-high grade HE groups (p=0.01), and between the ONSD and the low grade-high grade MRI groups (p<0.001). CONCLUSIONS Although high ONSD values do not make the diagnosis of cerebral edema, it may cause suspicion in the early period. MRI can be helpful in the diagnoses of increased intracranial pressure like ultrasound. Our study is the first study to compare ONSD and MRI findings in addition to HE grades. The widespread use of MRI in children in recent years may help determine the normal range of ONSD values.
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Affiliation(s)
- G M Doğan
- Inonu University, Pediatric Radiology, Malatya, Turkey.
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Kreft B, Tzschätzsch H, Shahryari M, Haffner P, Braun J, Sack I, Streitberger KJ. Noninvasive Detection of Intracranial Hypertension by Novel Ultrasound Time-Harmonic Elastography. Invest Radiol 2022; 57:77-84. [PMID: 34380993 DOI: 10.1097/rli.0000000000000817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A method for measuring intracranial pressure (ICP) noninvasively has long been sought after in neurology and neurosurgery. Treatment failure in individuals presenting with unspecific symptoms such as headache, gait disturbance, or visual impairment occurring in response to increased ICP can lead to irreversible brain injury, progressive disability, and death. Guidelines for diagnostic ICP measurement recommend intracranial placement of pressure tip catheters or lumbar puncture (LP) despite their invasiveness and possible complications. As ICP fluctuations are closely associated with changes in brain stiffness, ultrasound elastography could be a valid method to detect ICP noninvasively and with short examination times. MATERIALS AND METHODS In this pilot study, we have investigated the use of time-harmonic shear waves, introduced into the brain by an external shaker, and measured in real-time by transtemporal ultrasound, for deducing a noninvasive imaging marker sensitive to elevated ICP. To this end, we developed cerebral ultrasound time-harmonic elastography for the noninvasive quantification of shear wave speed (SWS) as a surrogate marker of cerebral stiffness in a short examination time of a few minutes. RESULTS We found that SWS in patients enrolled for LP with confirmed intracranial hypertension was 1.81 ± 0.10 m/s, distinguishing them from healthy volunteers with excellent diagnostic accuracy (1.55 ± 0.08 m/s; P < 0.001; area under the curve, 0.99). Interestingly, values in symptomatic patients decreased to normal stiffness immediately after LP (1.56 ± 0.06 m/s, P < 0.001). Moreover, invasively measured opening pressure correlated with SWS measured before LP and liquid volume drained through the spinal tap with the SWS difference between the 2 measurements. CONCLUSIONS Collectively, our results suggest a tight link between cerebral stiffness and ICP and demonstrate that intracranial hypertension can be detected noninvasively within short examination times, opening avenues for diagnostic applications of cerebral ultrasound time-harmonic elastography in neurology and emergency medicine.
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Affiliation(s)
| | | | | | - Paula Haffner
- Department of Neurology, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | | | - Kaspar-Josche Streitberger
- Department of Neurology, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Rufai SR, Jeelani NUO, Bowman R, Bunce C, Proudlock FA, Gottlob I. Recognition of intracranial hypertension using handheld optical coherence tomography in children (RIO Study): a diagnostic accuracy study protocol. BMJ Open 2022; 12:e048745. [PMID: 35017232 PMCID: PMC8753392 DOI: 10.1136/bmjopen-2021-048745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Paediatric intracranial hypertension (IH) is a rare but serious condition that can pose deleterious effects on the brain and vision. Estimating intracranial pressure (ICP) in children is difficult. Gold standard direct ICP measurement is invasive and carries risk. It is impractical to routinely perform direct ICP measurements over time for all children at risk of IH. This study proposes to assess the diagnostic accuracy of handheld optical coherence tomography (OCT), a non-invasive ocular imaging method, to detect IH in children. METHODS AND ANALYSIS This is a prospective study evaluating the diagnostic accuracy of handheld OCT for IH in at risk children. Inclusion criteria include clinical and/or genetic diagnosis of craniosynostosis, idiopathic intracranial hypertension, space occupying lesion or other conditions association with IH and age 0-18 years old. Exclusion criteria include patients older than 18 years of age and/or absence of condition placing the child at risk of IH. The primary outcome measures are handheld OCT and 48-hour ICP assessments, which will be used for diagnostic accuracy testing (sensitivity, specificity, positive predictive value, negative predictive value and accuracy). Main secondary outcome measures include visual acuity, fundoscopic examination, contrast sensitivity, visual field testing and visual evoked potentials, wherever possible. ETHICS AND DISSEMINATION Ethical approval was granted for this study by the East Midlands Nottingham 2 Research Ethics committee (UOL0348/IRAS 105137). Our findings will be disseminated through presentation at relevant meetings, peer-reviewed publication and via the popular media. TRIAL REGISTRATION NUMBER ISRCTN52858719.
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Affiliation(s)
- Sohaib R Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- Ulverscroft Eye Unit, University of Leicester, Leicester, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Noor Ul Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Richard Bowman
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catey Bunce
- Clinical Trials Unit, Royal Marsden Hospital NHS Trust, London, UK
| | | | - Irene Gottlob
- Ulverscroft Eye Unit, University of Leicester, Leicester, UK
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