Optic Nerve Sheath Diameter Used as Ultrasonographic Assessment of the Incidence of Raised Intracranial Pressure in Preeclampsia

Author:

Dubost Clément1,Le Gouez Agnès2,Jouffroy Viridiana1,Roger-Christoph Sandrine2,Benhamou Dan3,Mercier Frédéric J.4,Geeraerts Thomas5

Affiliation:

1. Resident in Anesthesiology and Intensive Care Medicine.

2. Staff Anesthesiologist.

3. Professor of Anesthesiology and Intensive Care Medicine and Chairman, AP-HP, Service d'Anesthésie-Réanimation, Hôpital Bicêtre, Le Kremlin-Bicêtre, France.

4. Professor of Anesthesiology and Intensive Care Medicine.

5. Consultant in Anesthesiology and Intensive Care Medicine, Département d'Anesthésie-Réanimation, Hôpital Antoine Béclère, Clamart, France.

Abstract

Background In some cases of severe preeclampsia/eclampsia, brain imaging displays signs compatible with raised intracranial pressure. We aimed to estimate the incidence of raised intracranial pressure in preeclampsia using ocular ultrasonography. Methods Optic nerve sheath diameter (ONSD) measurements were compared in 26 preeclamptic and 25 healthy pregnant women. For each optic nerve, two measurements were made (transverse plane and sagittal plane) using a 7.5 MHz ultrasound linear probe. Preeclamptic patients were followed-up until postpartum day 7. Results Median ONSD values were significantly greater in preeclamptic patients compared with healthy pregnant women at delivery (5.4 mm (95% CI: 5.2, 5.7) vs. 4.5 mm (95% CI: 4.3, 4.8), P < 0.0001). At delivery, 5/26 (19%) of preeclamptic patients had ONSD values above 5.8 mm (value associated in the literature with 95% risk of raised intracranial pressure) whereas none of the healthy pregnant group had such high ONSD values. In the preeclamptic group, ONSD decreased after the third postpartum day. ONSD values at day 7 were not significantly different from those obtained in the normal pregnancy group (P = 0.10). Conclusion In about 20% of preeclamptic patients, ONSD reaches values compatible with intracranial pressure above 20 mmHg. Further work is needed to confirm this incidence and to better understand the diagnostic and therapeutic usefulness of this easy-to-do monitoring technique.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

Reference27 articles.

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