Objective To identify evidence-based treatment choices for a patient with increased intracranial pressure after acute traumatic brain injury. Methods We searched The Cochrane Library (Issue 2, 2006), MEDLNE (1981 to August 2006) and CBMdisc (1978 to August 2006) to identity systematic reviews (SRs), randomized controlled trials (RCTs), controlled clinical trials (CCTs) and prospective cohort studies involving the efficacy and safety of pharmacotherapy and non-pharmacotherapy for increased intracranial pressure after acute traumatic brain injury. Results We found 2 SRs and 8 RCTs on pharmacotherapy, and 6 SRs and 2 RCTs on non-pharmacotherapy. Conventional-dose mannitol was no better than hypertonic saline, but was better than other intracranial pressure lowering agents. High-dose mannitol can reduce mortality and the incidence of severe disability compared with conventional-dose mannitol. There were no studies comparing high-dose mannitol and hypertonic saline. Non-pharmacotherapy was not recommended for routine use due to the lack of good quality evidence. Conclusion For patients with increased intracranial pressure after acute traumatic brain injury, mannitol is effective in reducing the mortality and the incidence of severe disability. However, more large-scale RCTs are required to compare high-dose mannitol versus other drugs. Non-pharmacotherapy is not recommended as an adjunct therapy at present.
The early diagnosis of increased intracranial pressure is of great value for the prognosis of neurological diseases. Non-invasive ocular multimodal imaging methods for intracranial pressure monitoring include optic nerve sheath diameter measurement and optical coherence tomography (OCT). Optic nerve sheath diameter measurement is the most convenient and efficient, and OCT has also been proven applicable for the early differentiation of papilledema associated with increased intracranial pressure. This editorial aims to detail the clinical value, diagnostic efficacy, and application scenarios of three imaging methods for optic nerve sheath diameter measurement and OCT in predicting increased intracranial pressure, clarifying that multimodal imaging methods help improve the monitoring system for increased intracranial pressure and provide guidance for early screening of intracranial pressure elevation. Given the promising application prospects of multimodal imaging in ophthalmology, it is suggested that ophthalmologists pay more attention to optic nerve sheath diameter and OCT results when facing patients suspected of having increased intracranial pressure, and conduct relevant basic and clinical research to further explore the application value of multimodal imaging in different age and disease conditions.