Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2015; 25(02): 173-176
DOI: 10.4103/0971-3026.155869
Neuroradiology

Can sonographic measurement of optic nerve sheath diameter be used to detect raised intracranial pressure in patients with tuberculous meningitis? A prospective observational study

Shruti V Sangani
Department of Emergency Medicine, BJ Medical College, Civil Hospital, Ahmedabad, Gujarat, India
,
Samira Parikh
Department of Emergency Medicine, BJ Medical College, Civil Hospital, Ahmedabad, Gujarat, India
› Author Affiliations
› Further Information
  PDF Download Permissions and Reprints

Abstract

CNS Tuberculosis can manifest as meningitis, arachnoiditis and a tuberculoma. The rupture of a tubercle into the subarachnoid space leads to Tuberculosis Meningitis (TBME); the resulting hypersensitivity reaction can lead to an elevation of the intracranial pressure and hydrocephalus. While bedside optic nerve sheath diameter (ONSD) ultrasonography (USG) can be a sensitive screening test for elevated intracranial pressure in adult head injury, little is known regarding ONSD measurements in Tuberculosis Meningitis. Objectives: The aim of this study was to determine whether patients with TBME had dilation of the optic nerve sheath, as detected by ocular USG performed in the emergency department (ED). Materials and Methods: We conducted a prospective, observational study on adult ED patients with suspected TBME. Patients underwent USG measurements of the optic nerve followed by MRI. The ONSD was measured 3 mm behind the globe in each eye. MRI evidence of basilar meningeal enhancement and any degree of hydrocephalus was suggestive of TBME. Those patients without evidence of hydrocephalus subsequently underwent a lumbar puncture to confirm the diagnosis. Exclusion criteria were age less than 18 and obvious ocular pathology. In total, the optic nerve sheath diameters of 25 adults with confirmed TBME were measured. These measurements were compared with 120 control patients. Results: The upper limit of normal ONSD was 4.37 mm in control group. Those patients with TBME had a mean ONSD of 5.81 mm (SD 0.42). These results confirm that patients with tuberculosis meningitis have an ONSD in excess of the control data (P < 0.001). Conclusion: The evaluation of the ONSD is a simple non-invasive and potentially useful tool in the assessment of adults suspected of having TBME.

Keywords

Ophthalmic Ultrasound - optic nerve sheath diameter - tuberculous meningitis


Publication History

Article published online:
30 July 2021

© 2015. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Hayreh SS. Pathogenesis of oedema of the optic disc (papilloedema), a preliminary report. Br J Ophthal 1964;48:522-43.
  • 2 Tintinalli JE, Stapczynski JS, Ma OJ, Cline DM, Cydulka RK, Meckler GD. Tintinalli′s Emergency Medicine: A Comprehensive Study Guide. 7 th edition: McGraw-Hill Medical; 2011.p. 1547-1549.
  • 3 De Castro CC, de Barros NG, Campos ZM, Cerri GG. CT scans of cranial tuberculosis. Radiol Clin North Am 1995;33:753-769.
  • 4 Pienaar M, Andronikou S, van Toorn R. MRI to demonstrate diagnostic features and complications of TBM not seen with CT. Childs Nerv Syst 2009;25:941-7.
  • 5 Munk PL, Vellet AD, Levin M, Lin DT, Collyer RT. Sonography of the eye. AJR Am J Roentgenol 1991;157:1079-86.
  • 6 Bergès O, Koskas P, Lafitte F, Piekarski JD. Sonography of the eye and orbit with a multipurpose ultrasound unit. J Radiol 2006;87:345-53.
  • 7 Hansen HC, Helmke K. Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: Ultrasound findings during intrathecal infusion tests. J Neurosurg 1997;87:34-40.
  • 8 Helmke K, Burdelski M, Hansen HC. Detection and monitoring of intracranial pressure dysregulation in liver failure by ultrasound. Transplantation 2000;70:392-5.
  • 9 Newman WD, Hollman AS, Dutton GN, Carachi R. Measurement of optic nerve sheath diameter by ultrasound: A means of detecting acute raised intracranial pressure in hydrocephalus. Br J Ophthalmol 2002;86:1109-13.
  • 10 Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med 2003;10:376-81.
  • 11 Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med 2007;49:508-14.
  • 12 Geeraerts T, Launey Y, Martin L, Pottecher J, Vigué B, Duranteau J, et al. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med 2007;33:1704-11.
  • 13 Kimberly HH, Shah S, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med 2008;15:201-4.
  • 14 American Institute of Ultrasound in Medicine, National Electrical Manufacturers Association. Safety Standard for Diagnostic Ultrasound Equipment. Laurel, MD: American Institute of Ultrasound in Medicine; Rosslyn, VA: National Electrical Manufacturers Association; 1981. AIUM/NEMA Standards Publication UL 1-1981; J Ultras Med 1983;2:1-50.