Intracranial Hypertension in Patients with Hemorrhagic Cerebrovascular Disease Diagnosed by Ocular Globe Ultrasonography in a Second-Level Hospital in Mexico

Introduction: Intracranial hypertension (ICH) is a serious complication characterized by increased pressure within the cranial cavity. Non-invasive techniques such as optic nerve sheath diameter (ONSD) measurement, the ONSD/transverse ocular diameter ratio (ONSD/TOD), and optic disc elevation (ODE) allow rapid, safe, bedside detection, facilitating timely diagnosis.

Problem statement: Cranial computed tomography and invasive intracranial pressure monitoring are the reference diagnostic methods; however, their availability is limited in second-level hospitals. Therefore, this study proposes ocular globe ultrasonography as a non-invasive alternative to identify intracranial hypertension and support therapeutic decision-making.

Objective: To evaluate the presence of intracranial hypertension in patients with hemorrhagic cerebrovascular disease using ocular globe ultrasonography in a second-level hospital.

Materials and methods: A prospective, analytical, cross-sectional study was conducted in 98 patients, 72 of whom were diagnosed in the Internal Medicine Department of the Hospital General Regional de Orizaba, Veracruz, between December 2024 and June 2025. ONSD, ONSD/TOD, and ODE were measured, and data were analyzed to determine sensitivity, specificity, positive predictive value, negative predictive value, and ROC curves.

Results: Of the 98 patients included, 72 were diagnosed by computed tomography. Intracranial hypertension was identified using ONSD in 69 patients (95.8%), while 3 patients (4.2%) showed no evidence. Sensitivity was 95.8% and specificity 84.6%. The ONSD/transverse ocular diameter ratio detected intracranial hypertension in 65 patients (90.3%) and absence in 7 patients (9.7%), with a sensitivity of 90.3% and specificity of 76.9%. Optic disc elevation was observed in 60 patients (83.3%), while 12 patients (16.7%) showed no alteration, with a sensitivity of 83.3% and specificity of 80.8%. The receiver operating characteristic curve for the three measurements showed an AUC of 0.95 (95% CI), compared with an AUC of 0.93 for ONSD alone.

Conclusions: The combination of ONSD, ONSD/TOD, and ODE provides greater sensitivity and specificity for detecting intracranial hypertension compared with the isolated use of ONSD, consolidating these parameters as useful tools for non-invasive neuromonitoring.