Sitanaya Shierly Novitawati, Kamayanti Fadhila, Nugroho Hari Adityo, Prabowo Bobi
Emergency Department, Dr. Iskak Tulungagung General Hospital, Tulungagung, East Java, Indonesia.
SAGE Open Med. 2022 Feb 17;10:20503121221077834. doi: 10.1177/20503121221077834. eCollection 2022.
Intracranial hypertension is an emergency condition that needs to be recognized as soon as possible. Lumbar puncture, the gold standard diagnostic procedure for intracranial hypertension, is contraindicated in some conditions while brain imaging procedures may be too difficult to be performed on critically ill patients. To solve this problem, this study aims to assess an alternative method to detect intracranial hypertension by measuring optic nerve sheath diameter using ocular ultrasound and optic nerve sheath diameter difference in each etiology.
This cross-sectional study was conducted at the Emergency Department of Dr Iskak Tulungagung General Hospital. Sixty-nine patients who visited the emergency room for the first onset of intracranial pathology were included for optic nerve sheath diameter measurement by ultrasound. Subjects were divided into elevated and non-elevated intracranial pressure groups based on head computed tomography scan findings. The optic nerve sheath diameter results were compared and analyzed.
There were 29 subjects in the elevated intracranial pressure group and 40 subjects in the non-elevated intracranial pressure group. The mean of optic nerve sheath diameter in the elevated and non-elevated intracranial pressure groups was 0.63 ± 0.06 and 0.57 ± 0.06 cm, respectively ( 0.000). Based on receiver operating characteristics analysis, 0.58 cm was the most optimal cut-off value.
Ultrasonographic optic nerve sheath diameter can be used to predict elevated intracranial pressure in suspected patients who are contraindicated to invasive intracranial pressure measurement or critically ill. There were significant differences between elevated and non-elevated intracranial pressure groups in stroke and trauma subjects.
颅内高压是一种需要尽快识别的紧急情况。腰椎穿刺作为颅内高压的金标准诊断程序，在某些情况下是禁忌的，而脑部成像程序对重症患者来说可能难以实施。为了解决这个问题，本研究旨在评估一种通过眼部超声测量视神经鞘直径及每种病因下视神经鞘直径差异来检测颅内高压的替代方法。
本横断面研究在伊斯卡克·图伦加贡综合医院急诊科进行。纳入69例因颅内病变首次就诊于急诊室的患者，通过超声测量视神经鞘直径。根据头部计算机断层扫描结果将受试者分为颅内压升高组和颅内压未升高组。对视神经鞘直径结果进行比较和分析。
颅内压升高组有29例受试者，颅内压未升高组有40例受试者。颅内压升高组和未升高组视神经鞘直径的平均值分别为0.63±0.06和0.57±0.06厘米（P = 0.000）。根据受试者工作特征分析，0.58厘米是最适宜的截断值。
超声测量的视神经鞘直径可用于预测颅内压测量禁忌或重症疑似患者的颅内压升高情况。在中风和创伤受试者中，颅内压升高组和未升高组之间存在显著差异。
