ABC Imagem Cardiovasc. 2026; 39(3): e20260097
Ultrasound Measurement of Optic Nerve Sheath Diameter in Acute Hypertensive States For Detection of Intracranial Involvement: A Meta-Analysis
DOI: 10.36660/abcimg.20260097i
Abstract
Background:
Detection of intracranial involvement in acute hypertension traditionally relies on fundoscopy, a method with limited applicability at the bedside. Ultrasonographic measurement of the optic nerve sheath diameter (ONSD) has emerged as a rapid, non-invasive alternative.
Objective:
To synthesize evidence on ONSD in adults and pregnant women with acute hypertensive states, assessing the difference in measurements between groups and its diagnostic performance for elevated intracranial pressure (ICP).
Methods:
Systematic review and meta-analysis following PRISMA guidelines. Three databases were searched through July 2026, including observational studies. The primary outcome was the standardized mean difference (Hedges’ g) in ONSD between hypertensive and control groups, using a random-effects model.
Results:
Fourteen studies (995 participants) were included. Nine studies (426 hypertensive and 283 control participants) provided combinable continuous data: ONSD was significantly higher in hypertensive patients (g = 1.55; 95% CI 1.06 to 2.04; p < 0.001; I² = 87.0%). Excluding a single discordant study reduced heterogeneity and strengthened the effect (g = 1.77; 95% CI 1.50 to 2.04; I² = 51.8%). In five studies with observed counts, the odds of ONSD above the threshold were higher in hypertensive patients (OR 11.58; 95% CI 1.45 to 92.85; I² = 73.7%). No study included ONSD with invasive ICP measurement.
Conclusion:
ONSD is consistently higher in acute hypertensive patients, with a robust effect. However, substantial heterogeneity, reliance on statistical conversions, the presence of a discordant study, and the absence of validation against the invasive gold standard warrant caution, underscoring the need for methodological standardization and dedicated validation.
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