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Optimal optic nerve sheath diameter threshold for the identification of elevated opening pressure on lumbar puncture in a Chinese population.

Wang L, Feng L, Yao Y, Wang Y, Chen Y, Feng J, Xing Y - PLoS ONE (2015)

Bottom Line: ONSD was a significant independent predictor of elevated opening pressure on LP (p<0.001).The cut-off point of this predictor in a Chinese population was remarkably lower than that found in a Caucasian population.Thus, ethnic differences should be noted when using the ONSD as an indicator of increased ICP.

View Article: PubMed Central - PubMed

Affiliation: The Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China.

ABSTRACT
Ultrasonography of the optic nerve sheath diameter (ONSD) is a non-invasive and rapid method that might be helpful in the identification of increased intracranial pressure (ICP). The use of an ONSD greater than 5 mm on ultrasound as an indicator of increased ICP in a Caucasian population has been studied. However, the cut-off point of this predictor in Chinese patients has not been established. Thus, we conducted this study to identify the ONSD criterion for the detection of elevated opening pressure on lumbar puncture (LP) in a Chinese population and to investigate the influencing factors. This study was a blind cross-sectional study. Patients who presented with suspected increased ICP were included. The opening pressure on LP of each participant was confirmed. We analyzed the clinical differences between the groups of patients with abnormal and normal opening pressures on LP. A receiver operating characteristic curve was constructed to determine the ONSD cut-off point for the identification of abnormal opening pressure on LP. In total, 279 patients were recruited, and 101 patients presented with elevated opening pressure on LP. ONSD was a significant independent predictor of elevated opening pressure on LP (p<0.001). However, no statistical significance was observed regarding the factors that might have affected this relationship including gender, age, body mass index, waistline, head circumference, hypertension and pathological subtype. The ONSD cut-off point for the identification of elevated opening pressure on LP was 4.1 mm; this cut-off yielded a sensitivity of 95% and a specificity of 92%. ONSD is a strong and accurate predictor of elevated opening pressure on LP. The cut-off point of this predictor in a Chinese population was remarkably lower than that found in a Caucasian population. Thus, ethnic differences should be noted when using the ONSD as an indicator of increased ICP.

No MeSH data available.


Related in: MedlinePlus

ONSD measurement.The ONSD measurement was assessed 3 mm posterior to the orbit. The ONSDs of the patient with increased ICPs were significantly enlarged.
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pone.0117939.g001: ONSD measurement.The ONSD measurement was assessed 3 mm posterior to the orbit. The ONSDs of the patient with increased ICPs were significantly enlarged.

Mentions: The ONSD measurements were performed prior to the LPs. The interval between these two examinations was less than 10 min. The ultrasonographic procedure was performed by a senior emergency medicine resident. Ultrasound examinations of the eye were performed in B-mode using a Philips iU22 (Andover, Massachusetts, USA) ultrasound system and a 9–3 MHz linear array transducer. The patients were examined in the supine position. The probe was placed lightly on the closed upper eyelid with a thick layer of ultrasound gel to prevent pressure from being exerted on the eye. The position of the probe was adjusted to clearly display the entry of the optic nerve into the globe. According to previous protocols, two measurements were performed for each optic nerve. The first measurement was performed in the sagittal plane with the probe in a vertical orientation, and the second measurement was performed the transverse plane with the probe in a horizontal orientation [6,20]. The ONSD was assessed bilaterally 3 mm posterior to the orbit [21,22] (Fig. 1). The measurements were repeated once for each eye, and a total of eight values were obtained. The final ONSD measurement value for each patient was derived from the average of the eight values to minimize variability. The opening pressure of the CSF was recorded in cm of water pressure (cm H2O) by LP, which was performed by a neurological resident who was experienced and blind to the ultrasonographic results. Patients were placed in a left lateral position with their hips and knees flexed and their heads as close to their knees as comfortably possible. The area around the lower back was prepared using an aseptic technique. We asked the patients to relax. Once the subarachnoid space had been entered, the patient straightened his/her legs, the opening pressure on LP was then recorded, and fluid samples were obtained. Elevated opening pressure on LP was defined as a pressure > 20 cm H2O [17,19]. Subsequently, the characteristic data of the ONSD measurement values and the pressures of the CSF measured through the LP were entered into the database.


Optimal optic nerve sheath diameter threshold for the identification of elevated opening pressure on lumbar puncture in a Chinese population.

Wang L, Feng L, Yao Y, Wang Y, Chen Y, Feng J, Xing Y - PLoS ONE (2015)

ONSD measurement.The ONSD measurement was assessed 3 mm posterior to the orbit. The ONSDs of the patient with increased ICPs were significantly enlarged.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4322040&req=5

pone.0117939.g001: ONSD measurement.The ONSD measurement was assessed 3 mm posterior to the orbit. The ONSDs of the patient with increased ICPs were significantly enlarged.
Mentions: The ONSD measurements were performed prior to the LPs. The interval between these two examinations was less than 10 min. The ultrasonographic procedure was performed by a senior emergency medicine resident. Ultrasound examinations of the eye were performed in B-mode using a Philips iU22 (Andover, Massachusetts, USA) ultrasound system and a 9–3 MHz linear array transducer. The patients were examined in the supine position. The probe was placed lightly on the closed upper eyelid with a thick layer of ultrasound gel to prevent pressure from being exerted on the eye. The position of the probe was adjusted to clearly display the entry of the optic nerve into the globe. According to previous protocols, two measurements were performed for each optic nerve. The first measurement was performed in the sagittal plane with the probe in a vertical orientation, and the second measurement was performed the transverse plane with the probe in a horizontal orientation [6,20]. The ONSD was assessed bilaterally 3 mm posterior to the orbit [21,22] (Fig. 1). The measurements were repeated once for each eye, and a total of eight values were obtained. The final ONSD measurement value for each patient was derived from the average of the eight values to minimize variability. The opening pressure of the CSF was recorded in cm of water pressure (cm H2O) by LP, which was performed by a neurological resident who was experienced and blind to the ultrasonographic results. Patients were placed in a left lateral position with their hips and knees flexed and their heads as close to their knees as comfortably possible. The area around the lower back was prepared using an aseptic technique. We asked the patients to relax. Once the subarachnoid space had been entered, the patient straightened his/her legs, the opening pressure on LP was then recorded, and fluid samples were obtained. Elevated opening pressure on LP was defined as a pressure > 20 cm H2O [17,19]. Subsequently, the characteristic data of the ONSD measurement values and the pressures of the CSF measured through the LP were entered into the database.

Bottom Line: ONSD was a significant independent predictor of elevated opening pressure on LP (p<0.001).The cut-off point of this predictor in a Chinese population was remarkably lower than that found in a Caucasian population.Thus, ethnic differences should be noted when using the ONSD as an indicator of increased ICP.

View Article: PubMed Central - PubMed

Affiliation: The Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Jilin University, Changchun, China.

ABSTRACT
Ultrasonography of the optic nerve sheath diameter (ONSD) is a non-invasive and rapid method that might be helpful in the identification of increased intracranial pressure (ICP). The use of an ONSD greater than 5 mm on ultrasound as an indicator of increased ICP in a Caucasian population has been studied. However, the cut-off point of this predictor in Chinese patients has not been established. Thus, we conducted this study to identify the ONSD criterion for the detection of elevated opening pressure on lumbar puncture (LP) in a Chinese population and to investigate the influencing factors. This study was a blind cross-sectional study. Patients who presented with suspected increased ICP were included. The opening pressure on LP of each participant was confirmed. We analyzed the clinical differences between the groups of patients with abnormal and normal opening pressures on LP. A receiver operating characteristic curve was constructed to determine the ONSD cut-off point for the identification of abnormal opening pressure on LP. In total, 279 patients were recruited, and 101 patients presented with elevated opening pressure on LP. ONSD was a significant independent predictor of elevated opening pressure on LP (p<0.001). However, no statistical significance was observed regarding the factors that might have affected this relationship including gender, age, body mass index, waistline, head circumference, hypertension and pathological subtype. The ONSD cut-off point for the identification of elevated opening pressure on LP was 4.1 mm; this cut-off yielded a sensitivity of 95% and a specificity of 92%. ONSD is a strong and accurate predictor of elevated opening pressure on LP. The cut-off point of this predictor in a Chinese population was remarkably lower than that found in a Caucasian population. Thus, ethnic differences should be noted when using the ONSD as an indicator of increased ICP.

No MeSH data available.


Related in: MedlinePlus