Temple University Hospital, Philadelphia, Pennsylvania.
Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
J Emerg Med. 2021 Feb;60(2):210-215. doi: 10.1016/j.jemermed.2020.09.029. Epub 2020 Oct 21.
Emergency physicians are frequently required to identify and triage patients with increased intracranial pressure (ICP). Idiopathic intracranial hypertension (IIH) is a possible cause that must be considered. Its prognosis depends on prompt recognition and treatment, and progression of the disease can lead to permanent vision loss and considerable morbidity. Point-of-care ultrasound can rapidly identify elevated ICP. Measurements of the optic nerve sheath diameter (ONSD) and optic disc elevation (ODE) can act as surrogates for ICP.
We describe five cases in which ultrasound was used to identify increased ICP and aid clinical decision-making. In several of the cases, ultrasound was used to confirm a suspicion for IIH and initiate therapy while awaiting the results of a more time-consuming and technically challenging test, such as lumbar puncture or optical coherence tomography. One of the patients was pregnant, and sonographic evidence of elevated ICP helped avoid exposing the patient to unnecessary radiation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Ultrasound is a quick and versatile tool for screening patients with neurologic symptoms, and when integrated into the proper clinical context, can reduce the use of more invasive tests. It can be particularly useful in patients with pathology that may not show abnormalities on computed tomography scan or in whom lumbar puncture is technically difficult, making patients at risk for IIH well-suited to examination by ultrasound. We use a cutoff of 5 mm for ONSD and 0.6 mm for ODE, though there are no universally agreed on cutoff values.
急诊医生经常需要识别和分诊颅内压增高（ICP）的患者。特发性颅内高压（IIH）是必须考虑的可能病因。其预后取决于及时识别和治疗，疾病的进展可导致永久性视力丧失和相当大的发病率。床边超声可以快速识别颅内压升高。视神经鞘直径（ONSD）和视盘隆起（ODE）的测量可以作为 ICP 的替代指标。
我们描述了五例使用超声识别颅内压增高并辅助临床决策的病例。在几个病例中，超声用于确认 IIH 的怀疑并开始治疗，同时等待更耗时和技术上更具挑战性的测试（如腰椎穿刺或光学相干断层扫描）的结果。其中一名患者怀孕，超声显示颅内压升高的证据有助于避免使患者暴露于不必要的辐射。
为什么急诊医生应该了解这一点？：超声是一种快速、多功能的筛查有神经系统症状的患者的工具，当整合到适当的临床环境中时，可以减少更具侵入性测试的使用。它在可能在计算机断层扫描上显示不出异常的患者或在腰椎穿刺技术上有困难的患者中特别有用，使患有 IIH 的患者非常适合超声检查。我们使用 ONSD 的 5 毫米和 ODE 的 0.6 毫米作为截断值，尽管没有普遍同意的截断值。
