![]() The height of the prominence has been found to be correlated with the severity of edema. On ultrasound, ODE is a contoured, hyperechoic prominence into the vitreous (Fig. This expansion of fluid can be detected by B scan ultrasound as widening of the optic nerve sheath diameter (ONSD), and/or potentially as optic disc elevation (ODE). Increasing ICP transmits across the subarachnoid space and causes accumulation of cerebrospinal fluid in the anterior part of the optic nerve, thereby causing distention and eventually papilloedema. ![]() Fundoscopy, in the hands of an experienced provider, may be a useful tool in detecting swelling of the optic disc-however, it is difficult to discriminate between true papilledema, pseudopapilledema, and other ocular conditions as their fundoscopic presentations often overlap. In lieu, edema of the optic disc has long been used as a proxy of ICP-since the meninges are continuous with the optic nerve sheath. Often, however, the invasive nature of these tests discourages their utilization. This began to be integrated into practice two decades ago, when a report detailing the benefits of ICP monitoring was published by The American Association of Neurological Surgeons. The gold standard of eICP detection and monitoring has historically been quite invasive-requiring extra-ventricular drainage or intra-ventricular catheters. In patients with traumatic brain injury, early detection and monitoring of eICP is of upmost importance. Identification of this perfusion–demand mismatch can allow for the initiation of therapies to decrease hypercarbia, prevent hypotension, and control secondary seizures. These conditions often result in a decrease of cerebral perfusion as a consequence of the eICP-thereby contributing to cerebral ischemia. eICP is difficult to detect, and patients may present with vague symptoms of headache, nausea and vomiting, visual disturbances, or decreased level of consciousness. eICP may present as a result of many etiologies including mass lesions, traumatic bleeds, hydrocephalus, obstruction, brain oedema, or in some cases, idiopathically. Further research on ODE elevation and its correlation with other ultrasonographic signs is warranted as a means to increase the diagnostic accuracy of ultrasound in the setting of eICP.Įlevated intracranial pressure (eICP) is an emergent condition that requires prompt identification and management. ODE and ultrasonographic characteristics of the optic disc may aid in differentiating papilledema from other conditions. ![]() The majority of studies reported a sensitivity between 70 and 90%, and specificity ranged from 69 to 100%, with a majority of studies reporting a specificity of 100%. Proposed cutoff values for ODE ranged between 0.3 mm and 1 mm. In patients with papilledema, the mean ODE ranged between 0.6 mm and 1.2 mm. The 29 articles included a total of 1249 adult and pediatric participants. After eliminating duplicates, and screening the records, we identified 29 articles that addressed ultrasonographically detected ODE. We systematically searched PubMed, EMBASE, and Cochrane Central for English articles published before April 2023 yielding 1,919 total citations. This systematic review followed the preferred reporting items for systematic reviews and meta-analyses guidelines. This systematic review seeks to explore the utility of ultrasound detected optic disc elevation (ODE) as an ultrasonographic finding of eICP and to study its sensitivity and specificity as a marker of eICP. Ocular ultrasound has emerged as a rapid, non-invasive, bedside tool to measure correlates of eICP. The current gold standards of eICP detection require patient transportation, radiation, and can be invasive. Elevated intracranial pressure (eICP) is a serious medical emergency that requires prompt identification and monitoring.
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