Noninvasive surrogates of intracranial pressure: another piece added with magnetic resonance imaging of the cerebrospinal fluid thickness surrounding the optic nerve

Optic nerve sheath diameter enlargement measured by ultrasound is known to be associated with raised intracranial pressure (ICP). Magnetic resonance imaging (MRI) of the cerebrospinal fluid (CSF) surrounding the optic nerve has been found, in an elegant study published in Critical Care, to correlate well with lumbar CSF opening pressure, confirming previously published studies. A simple and rapid T2-weighted fat-suppressed sequence was used to noninvasively measure the CSF width surrounding the optic nerve, allowing one to predict lumbar CSF pressure with relatively good performances, taking into consideration the body mass index and the mean arterial blood pressure. Based on these results and when brain MRI is indicated in situations at risk for increased ICP, the optic CSF thickness measurement could be systematically performed and used as a surrogate marker of raised ICP.