Related Experiment Video

Updated: Jul 10, 2026

Epidural Intracranial Pressure Measurement in Rats Using a Fiber-optic Pressure Transducer
09:04

Epidural Intracranial Pressure Measurement in Rats Using a Fiber-optic Pressure Transducer

Published on: April 25, 2012

21.0K

Optic Nerve Sheath Diameter by Point of Care Ultrasound to Detect Raised Intracranial Pressure in Children

Vaibhav Nagpal1, Prerna Batra1, Vikram Bhaskar1

  • 1Departments of Pediatrics.

Pediatric Emergency Care
|July 29, 2025
PubMed

Insights

Ultrasound measurement of optic nerve sheath diameter can detect raised intracranial pressure in children. An optimal cutoff of 4.92 mm shows high sensitivity but low specificity for this condition.

Area of Science:

  • Pediatric critical care medicine
  • Neurocritical care
  • Diagnostic imaging

Background:

  • Raised intracranial pressure (ICP) is a critical condition in pediatric intensive care units (PICU).
  • Accurate and timely diagnosis of elevated ICP is crucial for effective management and improved patient outcomes.
  • Non-invasive methods for detecting raised ICP are highly desirable in pediatric patients.

Purpose of the Study:

  • To determine the diagnostic performance of optic nerve sheath diameter (ONSD) measured by ultrasound for detecting raised ICP in children (1-12 years).
  • To establish the optimal ONSD cutoff value for identifying elevated ICP.
  • To assess changes in ONSD after osmotherapy and compare different osmotic agents.

Main Methods:

  • A prospective study involving 125 children admitted to the PICU with neurological signs and symptoms.
  • ONSD was measured using point-of-care ultrasound at admission and 30 minutes post-osmotherapy.
  • Patients were categorized into three groups: raised ICP, not raised ICP, and non-neurological controls.

Main Results:

  • Mean ONSD was significantly higher in children with raised ICP (5.48 ± 0.48 mm) compared to those without (5.14 ± 0.57 mm) and controls (4.54 ± 0.24 mm).
  • An ONSD >4.5 mm demonstrated 100% sensitivity but low specificity (AUC 0.53) for raised ICP.
  • An optimal cutoff of 4.92 mm yielded 90% sensitivity, 46.67% specificity, and an AUC of 0.68.
  • Osmotherapy led to a significant decrease in ONSD, with no difference between 3% saline and 20% mannitol.

Conclusions:

  • Ultrasound-measured ONSD is a sensitive tool for detecting raised ICP in children.
  • The optimal ONSD cutoff for raised ICP in this pediatric cohort is 4.92 mm, offering high sensitivity.
  • While sensitive, ONSD measurement has limited specificity for diagnosing raised ICP in children, necessitating careful clinical correlation.
Abstract

Keywords:
POCUSoptic nerve sheath diameterraised intracranial pressure

More Related Videos

Quantification of Optic Nerve Cross Sectional Area on MRI: A Novel Protocol using Fiji Software08:57

Quantification of Optic Nerve Cross Sectional Area on MRI: A Novel Protocol using Fiji Software

Published on: September 4, 2021

4.1K
Optic Nerve Sheath Point of Care Ultrasound: Image Acquisition06:09

Optic Nerve Sheath Point of Care Ultrasound: Image Acquisition

Published on: August 18, 2023

1.9K

Related Concept Videos

Glaucoma: Overview01:25

Glaucoma: Overview

Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...
Increased Intracranial Pressure l: Introduction01:14

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
Increased Intracranial Pressure ll: Pathophysiology01:29

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...