• Inessa Bekerman, Tal Sigal, Itzhak Kimiagar, Anna Ben Ely, and Michael Vaiman.
• Department of Radiology, Assaf Harofe Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Israel.
• Am J Emerg Med. 2016 Dec 1; 34 (12): 2336-2342.

BackgroundThe changes of the optic nerve sheath diameter (ONSD) have been used to assess changes of the intracranial pressure for 20 years. The aim of this research was to further quantify the technique of measuring the ONSD for this purpose.MethodsRetrospective study of computed tomographic (CT) data of 1766 adult patients with intracranial hypotension (n=134) or hypertension (n=1632) were analyzed. The eyeball transverse diameter (ETD) and ONSD were obtained bilaterally, and the ONSD/ETD ratio was calculated. The ratio was used to calculate the normal ONSD for patients and to estimate the intracranial pressure of the patients before and after the onset of the pathology. Correlation analysis was performed with invasively measured intracranial pressure, the presence or absence of papilledema, sex, and age.ResultsIn hypotension cases, the ONSD by CT was 3.4±0.7 mm (P=.03 against normative 4.4±0.8 mm). In cases with hypertension, the diameter was 6.9±1.3 (P=.02, with a cutoff value ˃5.5 mm). The ONSD/ETD ratio was 0.29±0.04 against 0.19±0.02 in healthy adults (P=.01).ConclusionThe ONSD and the ONSD/ETD ratio can indicate low intracranial pressure, but quantification is impossible at intracranial pressure less than 13 mm Hg. In elevated intracranial pressure, the ONSD and the ratio provide readings that correspond to readings in millimeters of mercury. The ONSD method, reinforced with additional calculations, may help to indicate a raised intracranial pressure, evaluate its severity quantitatively, and establish quantitative goals for treatment of intracranial hypertension, but the limitations of the method are to be taken into account.Copyright © 2016 Elsevier Inc. All rights reserved.

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