Ultrasound measurement of optic nerve sheath diameter pre- and post-lumbar puncture

Christopher K Schott; Mohammad I Hirzallah; Rock Heyman; Daniel N Lesky; Emily B Brant; Clifton W Callaway

doi:10.1186/s13089-020-00173-8

Ultrasound measurement of optic nerve sheath diameter pre- and post-lumbar puncture

Ultrasound J. 2020 May 13;12(1):26. doi: 10.1186/s13089-020-00173-8.

Authors

Christopher K Schott^{1

2}, Mohammad I Hirzallah³, Rock Heyman⁴, Daniel N Lesky⁵, Emily B Brant³, Clifton W Callaway⁶

Affiliations

¹ VA Pittsburgh Health Care Systems * Critical Care Service Line (124U), University Drive, Pittsburgh, PA, 15240, USA. [email protected].
² Department of Critical Care Medicine and Emergency Medicine, University of Pittsburgh, and University of Pittsburgh Medical Center (UPMC), 3550 Terrace Street Scaife Hall, Suite 600, Pittsburgh, PA, 15213, USA. [email protected].
³ University of Pittsburgh Multidisciplinary Critical Care Training Program, 3550 Terrace Street Scaife Hall, Suite 600, Pittsburgh, PA, 15213, USA.
⁴ Department of Neurology, University of Pittsburgh, and University of Pittsburgh Medical Center (UPMC), 300 Halket Street, Suite 4500, Pittsburgh, PA, USA, 15213.
⁵ School of Medicine 401 Scaife Hall, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.
⁶ Department of Emergency Medicine, University of Pittsburgh, and University of Pittsburgh, Medical Center (UPMC), 3600 Forbes at Meyran Avenue Forbes Tower, Suite 10028, Pittsburgh, PA, 15213, USA.

Abstract

Background: To test the hypothesis that optic nerve sheath diameter (ONSD) correlates with real-time changes in intracranial pressure, we performed ultrasound measurements of the ONSD in ambulatory patients undergoing elective lumbar puncture (LP). We conducted a prospective cohort study, including adult patients undergoing LP in a non-emergent setting. We measured ONSD perpendicular to the optic nerve at 3 mm behind the globe in both eyes in the traverse and sagittal planes, with the patient supine. The primary outcome was change in ONSD from pre-LP to post-LP. We calculated association of opening and closing LP pressures with changes in the pre- and post-LP ONSD measurements.

Results: The mean patient age was 49.0 years (SD = 37-61, range 19-67) with 21 females (72.4%) and 26 (89.7%) white American (not Hispanic or Latino). The average opening pressure and closing pressures were 20.4 cm and 13.5 cm with a difference of 6.9 cm, (95% CI 3.9-10.0 cm). Pressures between the participants with baseline ONSD measurement > 5 mm (average opening pressure = 21.3 cm) to those < 5 mm (20.2 cm) differed by 1.1 cm (95% CI - 5.7 to 8.0). Linear regression revealed no association between the sagittal, transverse, average, and change in ONSD measurements with the observed LP opening pressure, change in LP pressure, or volume of cerebral spinal fluid (CSF) drained.

Conclusions: In this study of ambulatory patients undergoing rapid decreases in ICP via elective LP, we detected no acute changes in ultrasonographic measurement of the ONSD.

Keywords: Intracranial pressure; Optic nerve sheath diameter; Ultrasound.