title: Initial evaluation of the intracranial pressure in cases of traumatic brain injury without hemorrhage.
abstract: Our objective was to apply the technique of measuring diameters of optic nerve sheath (ONSD) for the intracranial pressure assessment for the cases with traumatic head injury without hemorrhage. In a retrospective study, CT data of 720 adult patients were collected and analyzed. ONSDs were measured at the point where the ophthalmic artery crosses the optic nerve (anatomical landmark) together with the eyeball transverse diameter (ETD). The ONSD/ETD index was calculated. The correlation analysis was performed with gender, age, the Glasgow Coma Scale score, and the Glasgow Outcome Score. ONSD was enlarged in 82% cases (n=591). Enlarged right/left ONSDs were 6.7±1.0/6.7±0.9mm (cut-off value˃5.5mm). ONSD/ETD ratio was 0.28±0.05 against 0.19±0.02 in healthy adults (p=0.02). We did not find correlation between ONSD/ETD ratio with initial Glasgow Coma Scale score but there was an inverse correlation between ONSD/ETD ratio and the Glasgow Outcome Score (r=-0.64). We conclude that in majority of cases with traumatic head injury without hemorrhage the ONSD is significantly enlarged indicating elevated intracranial pressure even if CT scans are negative.
authors.affiliation: Department of Radiology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Inessa
authors.initials: I
authors.lastname: Bekerman
authors.affiliation: Department of Radiology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Tal
authors.initials: T
authors.lastname: Sigal
authors.affiliation: Neurology Department, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Itzhak
authors.initials: I
authors.lastname: Kimiagar
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel. Electronic address: vaimed@yahoo.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Vaiman
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000000981:diagnostic imaging; D015331:Cohort Studies; D005260:Female; D007839:Functional Laterality; D015600:Glasgow Coma Scale; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000209:etiology*; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D009186:Myelin Sheath / Q000473:pathology; D009900:Optic Nerve / Q000000981:diagnostic imaging; D015898:Tomography Scanners, X-Ray Computed; D055815:Young Adult
keywords: Brain edema; Brain swelling; CT scan; Intracranial pressure; Optic nerve sheath diameter; Traumatic head injury