Department of Neurology, Saarland University Medical Center, Homburg, Germany.
Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK.
Neurol Sci. 2019 Dec;40(12):2447-2457. doi: 10.1007/s10072-019-04015-x. Epub 2019 Jul 31.
Estimation of intracranial pressure (ICP) may be helpful in the management of neurological critically ill patients. It has been shown that ultrasonography of the optic nerve sheath diameter (ONSD) is a reliable tool for non-invasive estimation of increased intracranial pressure (ICP) at hospital admission or in intensive care. Less is known about the estimation of increased ICP and usefulness of ONSD in the prehospital setting. The aim of this review was to elucidate both prevailing and novel applications of ONSD for neurologists and critical care physicians.
In this review, we discuss the technique and the novel approach of ONSD measurement, the clinical applications of ONSD in neurology and critical care patients.
ONSD measurement is simple, easy to learn, and has diverse applications. ONSD has utility for ICP measurement in intracranial hemorrhage and ischemic stroke, meningitis and encephalitis, and idiopathic intracranial hypertension (IIH). It is also valuable for lesser known syndromes, where an increase of ICP is postulated, such as acute mountain sickness and posterior reversible encephalopathy syndrome. ONSD changes develop in inflammatory or ischemic optic neuropathies. Some papers demonstrate the usefulness of ONSD studies in symptomatic intracranial hypotension.
ONSD is a safe and low-cost bedside tool with the potential of screening patients who need other neuroimaging and those who may need an invasive measurement of ICP.
颅内压（ICP）的估测可能有助于神经危重症患者的管理。已经表明，视神经鞘直径（ONSD）超声检查是一种可靠的工具，可用于在入院或重症监护期间无创性估测颅内压升高（ICP）。ONSD 在院前环境中估测 ICP 升高和有用性的信息则较少。本综述的目的是阐明 ONSD 在神经科医生和重症监护医生中的普遍和新的应用。
在本综述中，我们讨论了 ONSD 测量的技术和新方法、ONSD 在神经科和重症监护患者中的临床应用。
ONSD 测量简单、易于学习，并且具有多种应用。ONSD 可用于测量颅内出血和缺血性卒中、脑膜炎和脑炎以及特发性颅内高压（IIH）患者的 ICP。它对于不太知名的综合征也有价值，例如推测 ICP 升高的急性高原病和后部可逆性脑病综合征。ONSD 变化发生在炎症性或缺血性视神经病变中。一些论文表明，ONSD 研究在有症状的颅内低血压患者中有用。
ONSD 是一种安全且低成本的床边工具，具有筛查需要其他神经影像学检查和可能需要进行 ICP 有创测量的患者的潜力。
