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J Neuroimaging. 2019 Feb 3. doi: 10.1111/jon.12604. [Epub ahead of print]

Ultrasonography Monitoring of Optic Nerve Sheath Diameter and Retinal Vessels in Patients with Cerebral Hemorrhage.

Author information

1
Stroke Unit, City of Health and Science University Hospital of Turin, Turin, Italy.
2
Cancer Epidemiology Unit and CPO Unit, and Division of Emergency Medicine and High Dependency Unit, Department of Medical Sciences, University of Turin, Turin, Italy.
3
Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.
4
Neuroradiology Unit, University of Piemonte Orientale, Novara, Italy.
5
Department of Neurology, Saarland University Medical Center, Homburg, Germany.

Abstract

BACKGROUND AND PURPOSE:

Evaluation of the diagnostic accuracy of optic nerve sheath diameter (ONSD) and Doppler indices of central retinal arteries and veins for the detection of increased intracranial pressure (ICP) in intracerebral hemorrhage (ICH) and of the usefulness of a second assessment of these variables in the monitoring of ICH.

METHODS:

A total of 46 acute ICH patients with (group 1, n = 25) and without (group 2, n = 21) clinical and radiological computed tomography signs of raised ICP and 40 healthy controls were recruited. The median binocular ONSD and Doppler indices of retinal vessels including resistive index (RI) and retinal venous pulsation (RVP) were compared among groups, both at admission and later during ICH monitoring.

RESULTS:

Median binocular ONSD showed higher accuracy for the detection of increased ICP (sensitivity and specificity 100%), while Doppler indices were less accurate (sensitivity 48% and specificity 95% for RI; 80% and 62% for RVP). In ICH patients, ONSD was significantly elevated in group 1 both at admission (6.40 mm [interquartile range [IQR] = .70] vs. 4.70 [.40]) and at control time (6.00 [.55] vs. 4.55 [.40]; P < .01), as well as RI (.79 [.11] vs. .77 [.03] and .80 [.06] vs. .75 [.35]; P = .01). RVP was significantly increased in group 1 only at admission (3.20 cm/s [1.05] vs. 2.00 [1.55], P = .02).

CONCLUSIONS:

Median binocular ONSD evaluation showed higher accuracy for the estimation of elevated ICP compared with Doppler indices of retinal vessels. The ONSD enlargement detected in the early phase of ICH persists at control time.

KEYWORDS:

intracerebral hemorrhage; intracranial pressure; optic nerve sheath diameter; retinal vessels

PMID:
30714259
DOI:
10.1111/jon.12604

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