Download PDF
CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2019; 38(04): 279-283
DOI: 10.1055/s-0036-1594301
Review Article | Artigo de Revisão
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Non-Invasive Intracranial Pressure Evaluation in an Emergency Room – Point-of-Care Ultrasonography

Avaliação não invasiva da pressão intracraniana em uma sala de emergência – ultrassonografia point-of-care
Daniel Damiani 
1   Pós-Graduação em Neurociências, Universidade Anhembi Morumbi, São Paulo, SP, Brazil
,
Durval Damiani
2   Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
› Author Affiliations
Further Information

Publication History

28 July 2016

30 August 2016

Publication Date:
24 November 2016 (online)

Also available at
   Permissions and Reprints

Abstract

Point-of-care ultrasound is modifying conducts in emergency care. The various medical specialties, in addition to traditional indications in cases of multiple trauma, are using this technique for rapid diagnosis at the bedside without patient mobilization and without radiation. Point-of-care ultrasound in neurocritical patients, through its transorbital window, can estimate the intracranial pressure by a non-invasive method. Through the measurement of the diameter of the optic nerve sheath 3 mm posterior to the retina, the intracranial pressure is estimated if the value of the diameter is > 5 mm, as it has been verified in other studies. The present article describes the most current data on this topic, and it also highlights the need for more multicentric and randomized trials to determine the correct cut-off points that represent the high sensibility and specificity of the method.

Resumo

A ultrassonografia point-of-care está modificando as condutas na sala de emergência. As diversas especialidades, além das indicações tradicionais ao politraumatizado, estão utilizando esta técnica para um rápido diagnóstico à beira do leito, sem a necessidade de mobilização do paciente e sem irradiação. Nos pacientes neurocríticos, a ultrassonografia point-of-care, através de sua janela transorbital, oferece uma técnica não invasiva para avaliação da pressão intracraniana. Por meio da medida do diâmetro da bainha do nervo óptico 3 mm posterior à retina, estima-se a pressão intracraniana se o valor desse diâmetro for superior a 5 mm, conforme verificado em alguns estudos. Este artigo apresenta os dados mais atuais sobre o tema, destacando, ainda, a necessidade de mais estudos multicêntricos, randomizados, para a correta determinação dos valores de corte que representem a alta sensibilidade e especificidade do método.

Keywords

point-of-care ultrasound - ultrasound in emergency room - ultrasound in neurocritical patients - optic nerve sheath ultrasound - intracranial hypertension - bedside point-of-care ultrasound

Palavras-chave

ultrassom point-of-care - ultrassom na sala de emergência - ultrassom em pacientes neurocríticos - ultrassom do diâmetro da bainha do nervo óptico - hipertensão intracraniana - ultrassonografia point of-care à beira do leito
 

  • References

  • 1 Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med 2011; 364 (08) 749-757
    CrossrefPubMedSearch in Google Scholar
  • 2 Ochoa-Pérez L, Cardozo-Ocampo A. Ultrasound applications in the central nervous system for neuroanaesthesia and neurocritical care. Rev Colomb Anestesiol 2015; 43 (04) 314-320
    CrossrefPubMedSearch in Google Scholar
  • 3 Mehrpour M, Oliaee Torshizi F, Esmaeeli S, Taghipour S, Abdollahi S. Optic nerve sonography in the diagnostic evaluation of pseudopapilledema and raised intracranial pressure: a cross-sectional study. Neurol Res Int 2015; 2015: 146059
    PubMedSearch in Google Scholar
  • 4 Soldatos T, Chatzimichail K, Papathanasiou M, Gouliamos A. Optic nerve sonography: a new window for the non-invasive evaluation of intracranial pressure in brain injury. Emerg Med J 2009; 26 (09) 630-634
    CrossrefPubMedSearch in Google Scholar
  • 5 Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care 2011; 15 (03) 506-515
    CrossrefPubMedSearch in Google Scholar
  • 6 Hansen HÇ, Helmke K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests. J Neurosurg 1997; 87 (01) 34-40
    CrossrefPubMedSearch in Google Scholar
  • 7 Shevlin C. Optic nerve sheath ultrasound for the bedside diagnosis of intracranial hypertension: pitfalls and potential. Critical Care Horizons 2015; 1: 22-30
    PubMedSearch in Google Scholar
  • 8 Marchese RF, Mistry RD, Scarfone RJ, Chen AE. Identification of optic disc elevation and the crescent sign using point-of-care ocular ultrasound in children. Pediatr Emerg Care 2015; 31 (04) 304-307
    CrossrefPubMedSearch in Google Scholar
  • 9 Lochner P, Cantello R, Brigo F. , et al. Transorbital sonography in acute optic neuritis: a case-control study. AJNR Am J Neuroradiol 2014; 35 (12) 2371-2375
    CrossrefPubMedSearch in Google Scholar
  • 10 Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med 2003; 10 (04) 376-381
    CrossrefPubMedSearch in Google Scholar
  • 11 Bäuerle J, Nedelmann M. Sonographic assessment of the optic nerve sheath in idiopathic intracranial hypertension. J Neurol 2011; 258 (11) 2014-2019
    CrossrefPubMedSearch in Google Scholar
  • 12 Soldatos T, Karakitsos D, Chatzimichail K, Papathanasiou M, Gouliamos A, Karabinis A. Optic nerve sonography in the diagnostic evaluation of adult brain injury. Crit Care 2008; 12 (03) R67
    CrossrefPubMedSearch in Google Scholar
  • 13 Geeraerts T, Launey Y, Martin L. , et al. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med 2007; 33 (10) 1704-1711
    CrossrefPubMedSearch in Google Scholar
  • 14 Geeraerts T, Merceron S, Benhamou D, Vigué B, Duranteau J. Non-invasive assessment of intracranial pressure using ocular sonography in neurocritical care patients. Intensive Care Med 2008; 34 (11) 2062-2067
    CrossrefPubMedSearch in Google Scholar
  • 15 Strumwasser A, Kwan RO, Yeung L. , et al. Sonographic optic nerve sheath diameter as an estimate of intracranial pressure in adult trauma. J Surg Res 2011; 170 (02) 265-271
    CrossrefPubMedSearch in Google Scholar
  • 16 Lochner P, Brio F, Zedde ML. , et al. Feasibility and usefulness of ultrasonography in idiopathic intracranial hypertension or secondary intracranial hypertension. BMC Neurol 2016; 16: 85-97
    CrossrefPubMedSearch in Google Scholar
  • 17 Goel RS, Goyal NK, Dharap SB, Kumar M, Gore MA. Utility of optic nerve ultrasonography in head injury. Injury 2008; 39 (05) 519-524
    CrossrefPubMedSearch in Google Scholar
  • 18 Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med 2007; 49 (04) 508-514
    CrossrefPubMedSearch in Google Scholar
  • 19 Kimberly HH, Shah S, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med 2008; 15 (02) 201-204
    CrossrefPubMedSearch in Google Scholar
  • 20 Moretti R, Pizzi B, Cassini F, Vivaldi N. Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. Neurocrit Care 2009; 11 (03) 406-410
    CrossrefPubMedSearch in Google Scholar
  • 21 Shirodkar CG, Rao SM, Mutkule DP, Harde YR, Venkategowda PM, Mahesh MU. Optic nerve sheath diameter as a marker for evaluation and prognostication of intracranial pressure in Indian patients: An observational study. Indian J Crit Care Med 2014; 18 (11) 728-734
    CrossrefPubMedSearch in Google Scholar
  • 22 Wang L, Feng L, Yao Y. , et al. Optimal optic nerve sheath diameter threshold for the identification of elevated opening pressure on lumbar puncture in a Chinese population. PLoS One 2015; 10 (02) e0117939
    CrossrefPubMedSearch in Google Scholar