Echographic criteria for the assessment of the optic nerve condition in intracranial hypertension

Purpose: to develop objective acoustic criteria of the condition of the optic nerve and its sheaths for an early diagnosis of intracranial hypertension (IH). Material and methods. The research involved 24 patients (average age 35.8 ± 8.5 years) with suspected IH. The control group consisted of 48 healthy subjects (average age 28.5 ± 9.5 years). Ultrasound examination of the retrobulbar part of the optic nerve (ON) included the measurement of the ON thickness with sheaths (ONSD) and without sheaths (OND) and the calculation of the ratio K = ONSD/ OND. Echodensitometry was used to evaluate the echographic density of the parenchyma and the sheaths of the optic nerve. All patients were tested with magnetic resonance imaging (MRI) to analyse brain images. Results. The biometrical parameters of ON in healthy subjects were as follows: ONS 2.64 ± 0.21 mm and ONSD — 4.60 ± 0.34 mm. In patients with suspected IH the average parameters of the ON diameter were as follows: ONS — 2.57 ± 0.25 mm and ONSD — 5.81 ± 0.42 mm. A comparative assessment of the ON thickness with and without sheaths showed that in the control group the values of ONS did not exceed 3.5 mm and ONSD did not exceed 5.0 mm. In patients with IH, the values of ONSD were significantly higher than those in the control group (p < 0.05). The ratio coefficient (K)=ONSD/ONS in the group of healthy subjects ranged from 1.53 to 2.0 and averaged 1.75 ± 0.14. In patients with IH the values of K exceeded 2.0 (2,40 ± 0.18). The analysis of acoustic density data showed a significant variability in the parameters of the ON sheaths echodensitometry in IH patients as compared to the norm. Conclusion. The echography of the ON makes it possible to determine the acoustic and biometric parameters of the ON with high accuracy, to assess its structure and relationship with the surrounding tissues. The ratio coefficient (K) of ONSD/ONS makes it possible to determine IH in the early stages of the disease, even in the absence of objective clinical criteria.

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