Annals of Emergency Medicine
Volume 53, Issue 6 , Pages 785-791 , June 2009

Bedside Sonographic Measurement of Optic Nerve Sheath Diameter as a Predictor of Increased Intracranial Pressure in Children

  • Audrey Le, MD

      Affiliations

    • Department of Pediatrics, University of Tennessee Health Sciences Center, Le Bonheur Children's Medical Center, Memphis, TN
    • Corresponding Author InformationAddress for correspondence: Audrey Le, MD, Le Bonheur Children's Medical Center, Emergency Department, 50 North Dunlap Street, Memphis, TN 38104
    • ,
  • Mary Ellen Hoehn, MD

      Affiliations

    • Department of Ophthalmology, University of Tennessee Health Sciences Center, Le Bonheur Children's Medical Center, Memphis, TN
    • ,
  • Mary E. Smith, MPH, RDMS

      Affiliations

    • Department of Ophthalmology, University of Tennessee Health Sciences Center, Le Bonheur Children's Medical Center, Memphis, TN
    • ,
  • Thomas Spentzas, MD

      Affiliations

    • Department of Pediatrics, University of Tennessee Health Sciences Center, Le Bonheur Children's Medical Center, Memphis, TN
    • ,
  • David Schlappy, BS

      Affiliations

    • Department of Pediatrics, University of Tennessee Health Sciences Center, Le Bonheur Children's Medical Center, Memphis, TN
    • ,
  • Jay Pershad, MD

      Affiliations

    • Department of Pediatrics, University of Tennessee Health Sciences Center, Le Bonheur Children's Medical Center, Memphis, TN

Received 29 July 2008 ,Revised 21 October 2008 ,Accepted 25 November 2008.

References 

  1. Liu D, Kahn M. Measurement and relationship of subarachnoid pressure of the optic nerve to intracranial pressures in fresh cadavers. Am J Ophthalmol. 1993;116:548–556
  2. Helmke K, Hansen HC. Fundamentals of transorbital sonographic evaluation of optic nerve sheath expansion under intracranial hypertension II (Patient study). Pediatr Radiol. 1996;26:706–710
  3. Hansen HC, Helmke K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests. J Neurosurg. 1997;87:34–40
  4. Newman WD, Hollman AS, Dutton GN, et al. Measurement of optic nerve sheath diameter by ultrasound: a means of detecting acute raised intracranial pressure in hydrocephalus. Br J Ophthalmol. 2002;86:1109–1113
  5. Korber F, Scharf M, Moritz J, et al. [Sonography of the optical nerve—experience in 483 children]. Rofo. 2005;177:229–235
  6. Ballantyne J, Hollmas AS, Hamilton R, et al. Transorbital optic nerve sheath ultrasonography in normal children. Clin Radiol. 1999;54:740–742
  7. Malayeri AA, Bavarian S, Mehdizadeh M. Sonographic evaluation of optic nerve diameter in children with raised intracranial pressure. J Ultrasound Med. 2005;24:143–147
  8. Tayal VS, Neulander M, Norton HJ, et al. 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;49:508–514
  9. Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med. 2003;10:376–381
  10. Kimberly HH, Shah S, Marill K, et al. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med. 2008;15:201–204
  11. Biros M. Head trauma. In:  Rosen P,  Barkin R editor. Emergency Medicine. St. Louis, MO: Mosby-Year Book; 1998;p. 416–447
  12. Gosbell AD, Barry WR, Favilla I, et al. Computer aided area measurement of ocular images. Australian New Zealand J Ophthalmol. 1987;15:341–348
  13. Ramji FG, Slovis TL, Baker JD. Orbital sonography in children. Pediatr Radiol. 1996;26:245–258

 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

 Supervising editor: Steven M. Green, MD

 Author contributions: AL and JP conceived the study and designed the trial. AL was responsible for patient recruitment and data management. MEH and MES provided training in ophthalmic sonography and served as independent reviewers of all images. TS assisted with recruiting. DS provided statistical advice and analyzed the data. AL and JP drafted the article, and all authors contributed substantially to its revision. AL takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. The authors have stated that no such relationships exist. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement.

 Publication date: Available online January 23, 2009.

 Reprints not available from the authors.

PII: S0196-0644(08)02067-2

doi: 10.1016/j.annemergmed.2008.11.025

Annals of Emergency Medicine
Volume 53, Issue 6 , Pages 785-791 , June 2009

Article Tools

* Image Usage & Resolution