Background
Estimation of the intracranial pressure level is important in patient’s condition assessment. If increased
intracranial pressure (IICP) is suspected, commonly the ophthalmoscopy is
performed, which could reveal papilledema - an
indirect evidence of raised pressure in central nervous system. IICP suspicion or
confirmation of its cause can be diagnosed on the basis of computed tomography
or magnetic resonance imaging. An ultrasound
examination of the eyeball is routinely used in ophthalmology in the diagnosis
of injury, presence of foreign bodies, lens trauma and retinal detachment. Ultrasound diagnosis of IICP has found its place in
emergency, anaesthesiology and intensive therapy, in patients with multiple
organ trauma, head injury or poisoning.
Aims and methods
The aim of the study is comparison of methods which indirectly measure
the level of intracranial pressure - ultrasound measurement of optic nerve
sheath (ONS), ophthalmoscopy and diagnostic
imaging performed in the same period of time. In
patients treated in the paediatric haematology/oncology clinic the ONS
measurement is performed during preliminary diagnosis, before lumbar puncture,
in case of clinical signs of IICP and before imaging studies of the brain. The measurement is performed on both eyes with high
frequency linear probe. Diameter of ONS is measured at a distance of 3 mm from
the edge of the retina.
Results and conclusion
Up to date 70 examinations
have been performed (420 measurements)
in 41 patients aged 1 - 16 (mean 6.7,
SD 3.68), with
diagnosis of acute lymphoblastic
leukaemia being most frequent (19/41 patients).
The ultrasound obtained
the ONS diameter values: average transverse
diameter 4.25 mm (SD
0.43), average longitudinal diameter 4.35 mm (SD 0.43). In 17 cases ophthalmoscopy ,
in 7 cases CT, in 17 cases
MRI was performed . No evidence of IICP was found. Ultrasound
studies revealed same status of intracranial pressure. Further studies are conducted.
