Bedside Optic Nerve Ultrasonography for Diagnosing Increased Intracranial Pressure
Authors: Toni Riveros, Alex Vengerovsky, James Town
Journal: Annals of Internal Medicine (2020)

Letters2 June 2020Bedside Optic Nerve Ultrasonography for Diagnosing Increased Intracranial PressureToni Riveros, MD, MPH, Alex Vengerovsky, MD, and James Town, MDToni Riveros, MD, MPHUniversity of Washington, Seattle, Washington (T.R., A.V., J.T.)Search for more papers by this author, Alex Vengerovsky, MDUniversity of Washington, Seattle, Washington (T.R., A.V., J.T.)Search for more papers by this author, and James Town, MDUniversity of Washington, Seattle, Washington (T.R., A.V., J.T.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-0077 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:We commend Koziarz and colleagues (1) for highlighting the accessibility and usefulness of bedside ultrasonography for measuring optic nerve sheath diameter to assess for intracranial hypertension, including its value in underresourced settings or when other tests are not feasible. We would like to contribute several additional points about the safety of ocular insonation.First, exposure to sonographic gel poses a risk for biotrauma. Although rare, allergic reactions ranging from contact dermatitis to anaphylaxis have been described (2). Contaminated gel also may be a source of infection, particularly when multidose bottles are used (3). Prevention of these risks ...References1. Koziarz A, Sne N, Kegel F, et al. Bedside optic nerve ultrasonography for diagnosing increased intracranial pressure. A systematic review and meta-analysis. Ann Intern Med. 2019;171:896-905. [PMID: 31739316]. doi:10.7326/M19-0812 LinkGoogle Scholar2. Chasset F, Soria A, Moguelet P, et al. Contact dermatitis due to ultrasound gel: a case report and published work review. J Dermatol. 2016;43:318-320. [PMID: 26346708] doi:10.1111/1346-8138.13066 CrossrefMedlineGoogle Scholar3. Oleszkowicz SC, Chittick P, Russo V, et al. Infections associated with use of ultrasound transmission gel: proposed guidelines to minimize risk. Infect Control Hosp Epidemiol. 2012;33:1235-1237. [PMID: 23143361] doi:10.1086/668430 CrossrefMedlineGoogle Scholar4. Shankar H, Pagel PS. Potential adverse ultrasound-related biological effects: a critical review. Anesthesiology. 2011;115:1109-1124. [PMID: 21866043] doi:10.1097/ALN.0b013e31822fd1f1 CrossrefMedlineGoogle Scholar5. U.S. Department of Health and Human Services, Food and Drug Administration, Center for Devices and Radiological Health. Information for Manufacturers Seeking Marketing Clearance of Diagnostic Ultrasound Systems and Transducers. U.S. Department of Health and Human Services, Food and Drug Administration, Center for Devices and Radiological Health; 2019. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Washington, Seattle, Washington (T.R., A.V., J.T.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-0077. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoBedside Optic Nerve Ultrasonography for Diagnosing Increased Intracranial Pressure Alex Koziarz , Niv Sne , Fraser Kegel , Siddharth Nath , Jetan H. Badhiwala , Farshad Nassiri , Alireza Mansouri , Kaiyun Yang , Qi Zhou , Timothy Rice , Samir Faidi , Edward Passos , Andrew Healey , Laura Banfield , Mark Mensour , Andrew W. Kirkpatrick , Aussama Nassar , Michael G. Fehlings , Gregory W.J. Hawryluk , and Saleh A. Almenawer Bedside Optic Nerve Ultrasonography for Diagnosing Increased Intracranial Pressure Alex Koziarz , Siddharth Nath , and Saleh A. Almenawer Metrics 2 June 2020Volume 172, Issue 11Page: 771-772KeywordsBradycardiaConflicts of interestContact dermatitisDisclosureHypertensionOptic nerveReflexesSafetySyncopeUltrasound imaging ePublished: 2 June 2020 Issue Published: 2 June 2020 Copyright & PermissionsCopyright © 2020 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...