Noninvasive evaluation of intracranial hypertension? Is there a gold standard?

Abstract

Computed tomography is essential in head injuried patients for the detection of structural damage to the brain. However, the ability of CT scanning to predict the presence or absence of intracranial hypertension has been debated in the literature. Since the optic nerve is part of the central nervous system and in case of raised pressure in the cerebrospinal fluid its sheath inflates. Based in this hypothesis the authors reviewed the role of the optic nerve sheat diameter in diagnosis intracranial hypertension after traumatic brain injury. This non-invasive method is useful to predict the risk of intracranial hypertension and select patients to ICP monitoring, especially in those with normal CT scans.

Resumo

A tomografia de crânio é um exame fundamental para avaliação estrutural dos pacientes com traumatismo craniano. Entretanto, a capacidade da tomografia em predizer a ausência ou presença de hipertensão intracraniana é controversa. Como o nervo óptico é parte do sistema nervoso central, em situações de hipertensão intracraniana há aumento da bainha neural. Com base nessas hipóteses, os autores revisaram o papel da análise do diâmetro da bainha do nervo óptico no diagnóstico de hipertensão intracraniana pós-traumatismo. Esse método não invasivo é útil para predizer os riscos de hipertensão intracraniana e selecionar os pacientes para monitorização da pressão intracraniana, principalmente naqueles com tomografia de crânio normal.

Keywords

Intracranial hypertension - optic nerve injuries - tomography

Palavras-chave

Hipertensão intracraniana - traumatismos do nervo óptico - tomografia

¹Neurosurgeon, Division of Neurological Surgery, Hospital Bom Jesus, Ponta Grossa, PR, Neurointensive Care Post Graduation Program, Hospital Sírio-Libanês, Sao Paulo, SP, Brazil.

²Head of Neurovascular Group and Supervisor of Division of Neurosurgery of Hospital das Clinicas, University of Sao Paulo, Sao Paulo, SP, Brazil.

³Intensivist, coordinator of Neurointensive Post Graduation Program, Hospital Sírio-Libanês, Sao Paulo, SP, Brazil.

⁴Head of Neurotraumatology Group of Division of Neurosurgery of Hospital das Clinicas, University of São Paulo, Sao Paulo, SP, Brazil.

⁵Neurosurgeon, Division of Neurosurgery of Hospital das Clinicas, University of São Paulo, São Paulo, SP, Brazil.

⁶Chairman, Division of Neurosurgery Hospital das Clinicas, University of Sao Paulo, São Paulo, SP, Brazil.