Ocular Color-Coded Sonography – A Promising Tool for Neurologists and Intensive Care Physicians

Abstract

Ocular color-coded duplex sonography (OCCS), when performed within the safety limits of diagnostic ultrasonography, is an easy noninvasive technique with high potential for diagnosis and therapy in diseases with raised intracranial pressure and vascular diseases affecting the eye. Despite the capabilities of modern ultrasound systems and its scientific validation, OCCS has not gained widespread use in neurological practice. In this review, the authors describe the technique and main parameter settings of OCCS systems to reduce potential risks as thermal or cavitational effects for sensitive orbital structures. Applications of OCCS are the determination of intracranial pressure in emergency medicine, and follow-up evaluations of idiopathic intracranial hypertension and ventricular shunting by measuring the optic nerve sheath diameter. A diameter of 5.7 – 6.0 mm corresponds well with symptomatically increased intracranial pressure (> 20 cmH2O). OCCS also helps to discriminate between different etiologies of central retinal artery occlusion – by visualization of a “spot sign” and Doppler flow analysis of the central retinal artery – and aids the differential diagnosis of papilledema. At the end perspectives are illustrated that combine established ultrasound methods such as transcranial color-coded sonography with OCCS.

Zusammenfassung

Bei der okulären Farbduplexsonografie handelt es sich um eine einfache und sichere Methode zur Diagnose und Therapiesteuerung bei Erkrankungen mit erhöhtem intrakraniellen Druck und vaskulären Augenerkrankungen. Trotz der technischen Möglichkeiten moderner Ultraschallgeräte und der wissenschaftlichen Validierung ist diese Methode in der alltäglichen neurologischen Routinediagnostik bisher wenig bekannt. Inhalt dieses Reviews ist die Beschreibung der Technik und der Geräteeinstellungen zur Risikoreduktion von potentiell schädlichen Effekten auf empfindliche Augenstrukturen durch Erwärmung oder Kavitation sowie die hauptsächlichen klinischen Anwendungsgebiete in der Neurologie und der Neuro-Ophthalmologie. Darunter zählt die Beurteilung eines erhöhten intrakraniellen Drucks in der Intensivmedizin und Verlaufskontrollen bei idiopathischer intrakranieller Hypertension und Kontrolle der Funktion von Ventrikelshunts. Hierbei wird der Optikusnervenscheidendurchmesser bestimmt, wobei Werte ab 5,7 – 6,0 mm gut mit einem symptomatisch erhöhten Hirndruck (> 20 cmH2O) korrelieren. Darüber hinaus ermöglicht die Methode die Differentialdiagnose von Zentralarterienverschlüssen (durch den Befund eines „Spot Signs“ und die Dopplerflussanalyse in der Zentralarterie) und Papillenödemen. Abschließend werden Perspektiven zur Kombination mit etablierten Ultraschallmethoden, wie der transkraniellen Dopplersonografie, beleuchtet.

Key words

CNS - eye - ultrasound color Doppler - intracranial hypertension - emergency medicine

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