Transcranial ultrasound to detect elevated intracranial pressure: comparison of septum pellucidum undulations and optic nerve sheath diameter.

Two ultrasound tests that can be used to assess increased intracranial pressure (ICP) at the bedside are described. In outpatients receiving lumbar puncture and in intensive care patients with invasive ICP monitoring, we measured the optic nerve sheath diameter (ONSD) with transbulbar B-mode sonography and septum pellucidum undulation (SPU) induced by repeated passive head rotation with transtemporal M-mode sonography. We assessed the sensitivity and specificity of ONSD and SPU in the prediction of ICP >20 cm H2O. For ONSD, sensitivity was 53% and specificity 100% (n = 35, p < 0.001). The sensitivity of the SPU test was 75% and the specificity 100% (n = 32, p < 0.001). Although the SPU test may not feasible in some patients, it has high sensitivity and specificity comparable to those of ONSD measurement. The SPU test and ONSD may be useful alternatives to fundoscopy in clinical routine, preferably in combination.