Detection and monitoring of intracranial pressure dysregulation in liver failure by ultrasound

Background Development of elevated intracranial pressure (ICP) in hepatic f ailure indicates poor prognosis. Its detection by invasive methods poses me thodological problems. We applied ultrasound studies of the optic nerves to noninvasively estimated ICP status, Methods. A total of 22 pediatric patients with hepatic failure mere examine d by serial B scan ultrasound and followed up clically. Outcome was scored as survival or death due to multiorgan failure (MOF) or raised ICP, In 18 p atients, transplantations were performed, Resulsts. Four patients died before transplantation was possible (raised IC P: n=3, MOF: n=1). After OLT there mere 10 survivors and 8 patients died (M OF: n=3, raised ICP: n=5). In 10 patients we found optic nerve sheath diame ter (ONSD) above normal limits. Eight patients died, mostly because of rais ed ICP (n=7). Only 2 of the 10 survivors experienced a transient ONSD incre ase, steadily normalized after transplantation. Preoperatively, normal ONSD was detected in four of seven patients. The outcome of these four eases wa s clearly superior (three survivors and one MOF) compared with abnormal pre -OLT ultrasound findings (raised ICP: n=3), Conclusion. Patients with poor prognosis related to raised ICP in pediatric liver failure can be identified by ultrasound measurement of ONSD without the disadvantages of invasive procedures. Although the exact intracranial p ressure level cannot be deduced from single examinations, ONSD trends can r eflect the evolution of ICP in hepatic encephalopathy.