Abstract
Purpose
We sought to determine whether dilation of the optic nerve sheath diameter (ONSD),
as detected at the bedside by emergency ultrasound (US), could reliably correlate
with patient blood pressure and whether there was a blood pressure cutoff point where
you would start to see abnormal dilation in the ONSD.
Methods
This was a single-blinded, prospective, observational trial from September 2010 to
April 2011. One hundred fifty patients presenting to the emergency department were
enrolled. There were 3 arms to the study with 50 patients in each arm: (1) ONSD in
normotensive/asymptomatic patients; (2) ONSD in hypertensive/asymptomatic patients;
and (3) ONSD in hypertensive/symptomatic patients. Ocular US was conducted on all
subjects.
Results
Neither the number of symptoms nor the type of symptom present in the hypertensive/symptomatic
group was able to significantly predict the average ONSD before treatment (P = .818 and .288, respectively). There was a significant correlation between both
systolic blood pressure (SBP) and diastolic blood pressure (DBP) with the ONSD in
all hypertensive patients. The best SBP and DBP cutoff point for abnormal ONSD was
166/82 mm Hg. Decrease in ONSD observed after blood pressure treatment was not statistically
significant (P = .073).
Conclusions
In conclusion, our study shows that practitioners can use bedside ocular US and a
blood pressure cutoff point to help predict whether patients require more aggressive
management of their symptomatic hypertension. Knowing the SBP and DBP readings that
lead to increased ONSD and increased intracranial pressure can help guide management
and treatment decisions at the bedside.
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Article Info
Publication History
Published online: December 28, 2011
Accepted:
September 23,
2011
Received in revised form:
September 21,
2011
Received:
August 25,
2011
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
