Ultrasound-Based Evaluation of Optic Nerve Sheath Diameter as a Predictor of Elevated Intracranial Pressure in Pakistani Population

Abstract

Background: Early detection of elevated intracranial pressure (ICP) is crucial for preventing neurological morbidity and mortality, yet resource constraints and the invasiveness of gold-standard ICP monitoring pose challenges in many clinical settings. Despite increasing evidence supporting optic nerve sheath diameter (ONSD) measurement via ultrasound as a non-invasive proxy, data specific to the Pakistani population remain limited. Objective: This study aimed to evaluate the diagnostic utility of ultrasound-based ONSD measurement as a predictor of elevated ICP in symptomatic Pakistani adults, hypothesizing a strong correlation between ONSD enlargement and clinical or imaging evidence of increased ICP. Methods: A prospective observational study was conducted at Farooq Hospital, Lahore, enrolling 96 adults aged 18–40 years with suspected elevated ICP. Inclusion required compatible symptoms and informed consent; individuals with prior ocular pathology or neurosurgical intervention were excluded. Bilateral ONSD was measured by blinded radiologists using standardized ultrasound protocols, and ICP status was determined using clinical and imaging criteria. Statistical analyses included chi-square tests, odds ratios, and logistic regression using SPSS v26. The study received ethical approval and complied with the Helsinki Declaration. Results: Elevated right ONSD was observed in 60.4% and left ONSD in 58.3% of participants. Elevated ONSD was associated with a significantly higher likelihood of raised ICP (odds ratio 9.14, 95% CI 1.88–44.36, p = 0.001), with strong bilateral agreement (kappa 0.797, p < 0.001). Conclusion: Ultrasound-based ONSD measurement is a reliable, non-invasive tool for detecting elevated ICP in the Pakistani population and may enhance early diagnosis and management in resource-limited settings.