Clinical review of non-invasive intracranial pressure measurement in medical cases

Abstract

Intracranial pressure (ICP) measurement plays a vital role in decision making in neurological emergencies. Invasive methods of ICP monitoring have been the gold standard. Advent of various non-invasive techniques has widened the option of ICP measurement in medical cases as well. We illustrate two cases where optic nerve sheath measurements helped in managing raised ICP and time the need for surgical intervention and review the literature on non-invasive ICP measurement.

Keywords

Non-invasive intracranial pressure measurement - optic nerve sheath diameter - transcranial Doppler and pulsatility index

• REFERENCES

• 1 Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W. et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med 2012; 367: 2471-81
• 2 Mizutani T, Manaka S, Tsutsumi H. Estimation of intracranial pressure using computed tomography scan findings in patients with severe head injury. Surg Neurol 1990; 33: 178-84
• 3 Miller MT, Pasquale M, Kurek S, White J, Martin P, Bannon K. et al. Initial head computed tomographic scan characteristics have a linear relationship with initial intracranial pressure after trauma. J Trauma 2004; 56: 967-72
• 4 Marshall LF, Marshall SB, Klauber MR. A new classification of head injury based on computerised tomography. J Nuerosurg 1991; 75: S14-20
• 5 Rosenberg JB, Shiloh AL, Savel RH, Eisen LA. Non-invasive methods of estimating intracranial pressure. Neurocrit Care 2011; 15: 599-608
• 6 Alperin NJ, Lee SH, Loth F, Raksin PB, Lichtor T. MR-Intracranial pressure (ICP): A method to measure intracranial elastance and pressure noninvasively by means of MR imaging: Baboon and human study. Radiology 2000; 217: 877-85
• 7 Bellner J, Romner B, Reinstrup P, Kristiansson KA, Ryding E, Brandt L. Transcranial Doppler sonography pulsatility index (PI) reflects intracranial pressure (ICP). Surg Neurol 2004; 62: 45-51
• 8 Behrens A, Lenfeldt N, Ambarki K, Malm J, Eklund A, Koskinen LO. Transcranial Doppler pulsatility index: Not an accurate method to assess intracranial pressure. Neurosurgery 2010; 66: 1050-7
• 9 Voulgaris SG, Partheni M, Kaliora H, Haftouras N, Pessach IS, Polyzoidis KS. Early cerebral monitoring using the transcranial Doppler pulsatility index in patients with severe brain trauma. Med Sci Monit 2005; 11: CR49-52
• 10 Homburg AM, Jakobsen M, Enevoldsen E. Transcranial Doppler recordings in raised intracranial pressure. Acta Neurol Scand 1993; 87: 488-93
• 11 Moreno JA, Mesalles E, Gener J, Tomasa A, Ley A, Roca J. et al. Evaluating the outcome of severe head injury with transcranial Doppler ultrasonography. Neurosurg Focus 2000; 8: e8
• 12 Zweifel C, Czosnyka M, Carrera E, de Riva N, Pickard JD, Smielewski P. Reliability of the blood flow velocity pulsatility index for assessment of intracranial and cerebral perfusion pressures in head-injured patients. Neurosurgery 2012; 71: 853-61
• 13 Qian SY, Fan XM, Yin HH. Transcranial Doppler assessment of brain death in children. Singapore Med J 1998; 39: 247-50
• 14 Bandyopadhyay S, Jakobson D, Chhabra KD, Baker A. Improvement of cerebral blood flow patterns in hepatorenal syndrome using sustained low-efficiency dialysis. Br J Anaesth 2010; 105: 547-8
• 15 Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care 2011; 15: 506-15
• 16 Tayal VS, Neulander M, Norton HJ, Foster T, Saunders T, Blaivas M. Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med 2007; 49: 508-14
• 17 Hansen HC, Lagrèze W, Krueger O, Helmke K. Dependence of the optic nerve sheath diameter on acutely applied subarachnoidal pressure - an experimental ultrasound study. Acta Ophthalmol 2011; 89: e528-32
• 18 Rajajee V, Fletcher JJ, Rochlen LR, Jacobs TL. Comparison of accuracy of optic nerve ultrasound for the detection of intracranial hypertension in the setting of acutely fluctuating vs stable intracranial pressure: Post-hoc analysis of data from a prospective, blinded single center study. Crit Care 2012; 16: R79
• 19 Launey Y, Nesseler N, Le Maguet P, Mallédant Y, Seguin P. Effect of osmotherapy on optic nerve sheath diameter in patients with increased intracranial pressure. J Neurotrauma 2014; 31: 984-8
• 20 Geeraerts T, Newcombe VF, Coles JP, Abate MG, Perkes IE, Hutchinson PJ. et al. Use of T2-weighted magnetic resonance imaging of the optic nerve sheath to detect raised intracranial pressure. Crit Care 2008; 12: R114
• 21 Sekhon MS, Griesdale DE, Robba C, McGlashan N, Needham E, Walland K. et al. Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury. Intensive Care Med 2014; 40: 1267-74
• 22 Sekhon MS, McBeth P, Zou J, Qiao L, Kolmodin L, Henderson WR. et al. Association between optic nerve sheath diameter and mortality in patients with severe traumatic brain injury. Neurocrit Care 2014; 21: 245-52
• 23 Chen JW, Gombart ZJ, Rogers S, Gardiner SK, Cecil S, Bullock RM. Pupillary reactivity as an early indicator of increased intracranial pressure: The introduction of the Neurological Pupil index. Surg Neurol Int 2011; 2: 82
• 24 Kampfl A, Pfausler B, Denchev D, Jaring HP, Schmutzhard E. Near infrared spectroscopy (NIRS) in patients with severe brain injury and elevated intracranial pressure. A pilot study. Acta Neurochir Suppl 1997; 70: 112-4
• 25 Oddo M, Bösel J. Participants in the International Multidisciplinary Consensus Conference on Multimodality Monitoring. Monitoring of brain and systemic oxygenation in neurocritical care patients. Neurocrit Care 2014; 21 Suppl (Suppl. 02) S103-20
• 26 Shimbles S, Dodd C, Banister K, Mendelow AD, Chambers IR. Clinical comparison of tympanic membrane displacement with invasive intracranial pressure measurements. Physiol Meas 2005; 26: 1085-92