Neuropediatrics 2011; 42 - V12
DOI: 10.1055/s-0031-1273961

Optic nerve sheath diameter by ultrasound in children and adolescents with headache

B Gebhardt 1, A Büchel 2
  • 1Medizinisches Versorgungszentrum Gelnhausen, Gelnhausen, Germany
  • 2Main Kinzig Kliniken, Kinder- und Jugendmedizin, Gelnhausen, Germany

Measurements of the optic nerve sheath diameter (ONSD) by bedside ultrasound have been shown to correlate with increased intracranial pressure (ICP). Kimberly et al (Acad Emerg Med 2008) showed a correlation of ONSD >5mm with an increased ICP >20 mmH2O. Headaches are a common symptom in neuropediatric patients. Differenzial diagnosis according intracranial processes often reveals to be challenging.

Patients and Methods: In 185 Patients with the symptom of headaches as well as other symptoms ONSD was determined by ultrasound (Hitachi linear array 10MHz) as well as by fundusscopy. 2 measurements per eye were performed. Patient's age was 2–22 years (median 12). According to Kimberley et al. further investigations with cranial imaging and measurement of CSF pressure was recommended when ONSD was >5mm.

Results: In 41 patients ONSD was >5mm. In 5 patients an engorged papilla was found, in one patient revealing as druse papilla. In all patients cranial imaging was done revealing infratentorial astrocytoma in one patient, subdural bleeding in on patient and mastoiditis in one patient. In 5 patients CSF pressure measurement (CPM) was refused. CPM was performed in 33 patients (11–46 cmH2O; median 26). 29 patients showed pressure >20 cmH2O, 4 patients <20 cmH2O (11; 14; 16; 18 cmH2O), of these 2 (16; 18 cmH2O) had no further headache after measurements and ONSD normalized. 23 patients had no pathological finding in CSF. In 5 patients serous meningitis without germ identification was detected. 1 time enterovirus, 1 time norovirus and in two patients neuroborreliosis was revealed. 1 patient had persisting unclear protein elevation.

Discussion: The depicted results reveal the ONSD measurement by ultrasound as a sensitive and easy to perform method for determination of increased intracranial pressure. In children and adolescents with headaches this method seems to be a strong tool in the separation of intracranial pathology against the frequent problems of tension headache and migraine. Further data of the patients will be presented.