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Abstract：
Brain infections cause significant morbidity and mortality worldwide, especially in resource-limited settings with high HIV co-infection rates. Raised intracranial pressure [ICP] may complicate brain infection and worsen neurological injury, yet invasive ICP monitoring is often unavailable. Optic nerve sheath diameter [ONSD] ultrasound may allow detection of raised ICP at the bedside; however, pathology in brain infection is different to traumatic brain injury, in which most studies have been performed. The use of ONSD ultrasound has been described in tuberculous meningitis, cryptococcal meningitis and cerebral malaria; however correlation with invasive ICP measurement has not been performed. Normal optic nerve sheath values are not yet established for most populations, and thresholds for clinical intervention cannot be assumed to match those used in non-infective brain pathology. ONSD ultrasound may be suitable for use in resource-limited settings by clinicians with limited ultrasound training. Standardisation of scanning technique, consensus on normal ONSD values, and action on abnormal results, are areas for future research. This scoping review examines the role of ONSD ultrasound in brain infection. We discuss pathophysiology, and describe the rationale, practicalities, and challenges of utilising ONSD ultrasound for brain infection monitoring and management. We discuss the existing evidence base for this technique, and identify knowledge gaps and future research priorities.
摘要：
脑部感染在全球范围内导致显著的发病率和死亡率，特别是在资源有限的环境中，艾滋病毒合并感染率很高。颅内压[ICP]升高可能会使脑部感染复杂化并加重神经损伤，然而,通常无法进行侵入性ICP监测.视神经鞘直径[ONSD]超声可以检测床边升高的ICP;然而，脑感染的病理学不同于创伤性脑损伤，其中进行了大多数研究。已经描述了在结核性脑膜炎中使用ONSD超声，隐球菌性脑膜炎和脑型疟疾；然而，尚未与侵入性ICP测量相关。大多数人群的正常视神经鞘值尚未确定，不能认为临床干预的阈值与非感染性脑病理学中使用的阈值相匹配。ONSD超声可能适用于具有有限超声培训的临床医生在资源有限的环境中使用。扫描技术的标准化，对正常ONSD值的共识，并对异常结果采取行动，是未来研究的领域。这项范围审查检查了ONSD超声在脑部感染中的作用。我们讨论病理生理学，并描述其基本原理，实用性,以及利用ONSD超声监测和管理脑部感染的挑战。我们讨论了这种技术的现有证据基础，并确定知识差距和未来的研究重点。
