Elevated Intracranial Pressure Essay

Elevated intracranial pressure (ICP) is a common and potentially life threatening condition arising from a variety of pathological conditions including traumatic brain injury (TBI), intracranial hemorrhage, disturbance of cerebral spinal fluid (CSF) circulation and brain tumors. Although ventriculostomy continues to be the gold standard modality, the potential risks of misplacement, infection, hemorrhage and obstruction have led to development and implementation of alternative intracranial devices and techniques for monitoring ICP1. Recently, transorbital ultrasonography has gained popularity as it is a noninvasive bedside exam that has been shown to be useful for detecting raised ICP by evaluating the change in the optic nerve sheath diameter (ONSD)2-4. …show more content…
Multiple studies have compared ONSD directly to ventriculostomy and have demonstrated that there is a significant increase in ONSD above a certain threshold of ICP (≥ 20 mmHg) in neurocritically ill patients (ref). However, there still remains uncertainty regarding the degree or significance of ONSD changes below this threshold (ref). In addition, although it has been illustrated that distention of the ONSD occurs rapidly in response to elevated ICP5, there continues to be debate on the reversibility of the ONSD ranging from complete reversibility with CSF pressure changes6 to a delayed5 and even incomplete recovery when pressures have exceeded 40-45 mmHg7. Therefore, the relationship between ONSD and response to acute fluctuations and reversibility remains to be further