[1]Department of Neurology, First Hospital of Jilin University Changchun, China.
Background & Purpose: Ultrasonography of optic nerve sheath may help identify raised intracranial pressure (ICP). As reported, an ONSD (optic nerve sheath diameter) above 5 mm on ultrasound was indicated for raised ICP in Caucasian population. However, ONSD cut-off for raised ICP in Chinese patients has not been established. We aim to identify the optimal ONSD for raised ICP∗ in Chinese. Methods: This is a prospective observational study enrolling patients who were suspected raised ICP and performed lumbar puncture to verify ICP. ICP > 20 cmH2O∗ was considered as abnormally high. We excluded patients with ophthalmic diseases. ONSD was carried out before lumbar puncture. ONSD was measured bilaterally 3 mm behind the globe using a 9 MHz linear probe on the closed eyelids of supine patients. The average of two ONSD measurements was calculated. We analysed clinical differences between abnormal and normal ICP groups. An ROC curve was constructed to determine the optimal ONSD cut-off point for abnormal ICP. Results: Totally 234 patients were recruited. Eighty-two patients had raised ICP (152 normal ICP). Multivariate analysis showed ONSD was the only independent predictor for raised ICP. ROC curve analysis revealed area under the curve = 0.949 (95% CI 0.917-0.981). Optimal ONSD cut-off point for detection of raised ICP was ≥3.78 mm∗ with sensitivity of 90.2% and specificity of 96.1%. Conclusions: The ONSD criterion for raised ICP in Chinese patients is remarkedly less than Caucasian. It suggests that ethnic differences should be noted and applied corresponding ultrasonographic criteria when ONSD was used to diagnose raised ICP.
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