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Tian J, Wu GB, Liu XB, Wang ZY, Guo JY. The Effect of Different Optic Nerve Sheath Diameter Measurements Using Ultrasound to Assess Intracranial Pressure in Patients With Acute Brain Injury. J Neuroophthalmol 2024; 44:201-205. [PMID: 37440369 DOI: 10.1097/wno.0000000000001942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND Optic nerve sheath diameter (ONSD) is a promising, noninvasive invasive intracranial pressure (ICP) measurement method. This study aims to analyze the differences in ONSD between the left and right eyeballs and the differences in ultrasonic measurement between the transverse and sagittal planes. METHODS Data from a total of 50 eligible patients with various types of brain injury who were admitted to our hospital from May 2019 to June 2021 were analyzed. An ONSD assessment was then performed using Philips B-mode ultrasound, measuring ONSD 3 mm posterior to the eyeballs. The left and right ONSDs in the transverse and sagittal planes were measured. Intraparenchymal fiber optic sensors and catheters were inserted into the ventricles and connected to an external pressure transducer to measure ICP. RESULTS A total of 164 sonographic measurements of ONSD were performed in 50 patients with brain injury in a prospective observational study. Statistically significant differences were found in ONSD between the transverse and sagittal planes. The difference in the left ONSD between the transverse and sagittal planes was 0.007 ± 0.030 cm ( P = 0.003). The Spearman rank correlation test showed that the correlation coefficient between ICP and left/right ONSD in the transverse/sagittal planes was 0.495 vs 0.546 and 0.559 vs 0.605, respectively. The results showed that the areas under the curve of ONSD in the transverse and sagittal planes were 0.843 and 0.805, respectively. Medcalc software was used to compare the areas under the receiver operator characteristic curve, and the results showed that ONSD in the sagittal plane is generally better than in the transverse plane ( P = 0.0145). CONCLUSIONS This study found that ONSD in the sagittal plane is superior to the transverse plane regarding the comprehensive efficacy of ICP, and unilateral measurement is sufficient.
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Affiliation(s)
- Jun Tian
- Department of Neurosurgery (JT), Shijiazhuang People's Hospital, Shijiazhuang, Hebei, China; Department of Neurosurgery (G-BW), The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China; and Departments of Neurosurgery (X-BL) and Critical Care Medicine (Z-YW, J-YG), The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Zipfel J, Kerscher SR, Dhillon K, Ferraris KP, Singhal A. Optic nerve sheath diameter correlates with both success and failure of hydrocephalus treatment in pediatric patients with pineal region lesions. Acta Neurochir (Wien) 2024; 166:236. [PMID: 38805061 DOI: 10.1007/s00701-024-06122-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Pineal region lesions in children are heterogenous pathologies often symptomatic due to occlusive hydrocephalus and thus elevated intracranial pressure (ICP). MRI-derived parameters to assess hydrocephalus are the optic nerve sheath diameter (ONSD) as a surrogate for ICP and the frontal occipital horn ratio (FOHR), representing ventricle volume. As elevated ICP may not always be associated with clinical signs, the adjunct of ONSD could help decision making in patients undergoing treatment. The goal of this study is to assess the available magnetic resonance imaging (MRI) of patients with pineal region lesions undergoing surgical treatment with respect to pre- and postoperative ONSD and FOHR as an indicator for hydrocephalus. METHODS Retrospective data analysis was performed in all patients operated for pineal region lesions at a tertiary care center between 2010 and 2023. Only patients with pre- and postoperative MRI were selected for inclusion. Clinical data and ONSD at multiple time points, as well as FOHR were analyzed. Imaging parameter changes were correlated with clinical signs of hydrocephalus before and after surgical treatment. RESULTS Thirty-three patients with forty operative cases met the inclusion criteria. Age at diagnosis was 10.9 ± 4.6 years (1-17 years). Hydrocephalus was seen in 80% of operative cases preoperatively (n = 32/40). Presence of hydrocephalus was associated with significantly elevated preoperative ONSD (p = 0.006). There was a significant decrease in ONSD immediately (p < 0.001) and at 3 months (p < 0.001) postoperatively. FOHR showed a slightly less pronounced decrease (immediately p = 0.006, 3 months p = 0.003). In patients without hydrocephalus, no significant changes in ONSD were observed (p = 0.369). In 6/6 patients with clinical hydrocephalus treatment failure, ONSD increased, but in 3/6 ONSD was the only discernible MRI change with unchanged FOHR. CONCLUSIONS ONSD measurements may have utility in evaluating intracranial hypertension due to hydrocephalus in patients with pineal region tumors. ONSD changes appear to have value in assessing hydrocephalus treatment failure.
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Affiliation(s)
- Julian Zipfel
- Division of Pediatric Neurosurgery, B.C. Children's Hospital, Vancouver, BC, Canada.
- Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Susanne R Kerscher
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Karan Dhillon
- Division of Pediatric Neurosurgery, B.C. Children's Hospital, Vancouver, BC, Canada
| | - Kevin Paul Ferraris
- Division of Pediatric Neurosurgery, B.C. Children's Hospital, Vancouver, BC, Canada
| | - Ash Singhal
- Division of Pediatric Neurosurgery, B.C. Children's Hospital, Vancouver, BC, Canada
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Kishore KV, Patwardhan A, Aravinda HR, Mustare V, Ramakrishnan S. Characterization of Ocular Sonography Findings and their Relationship to Clinical Features from a South Indian Cohort of Idiopathic Intracranial Hypertension. Ann Indian Acad Neurol 2024; 27:146-151. [PMID: 38751906 PMCID: PMC11093174 DOI: 10.4103/aian.aian_1057_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 03/17/2024] [Accepted: 03/20/2024] [Indexed: 05/18/2024] Open
Abstract
Background Idiopathic intracranial hypertension (IIH) typically manifests with headache, accompanied by papilledema and visual loss, and has a higher prevalence in females. In recent years, ocular sonography, particularly, measurement of optic nerve sheath diameter (ONSD), is being investigated for diagnosis of IIH. Methods A total of 35 patients over the age of 18 years, fulfilling the modified Dandy's criteria for diagnosis of IIH were included. Patients underwent assessment with magnetic resonance imaging, lumbar puncture, and ocular sonography to measure ONSD and ocular arterial indices. Results The mean ONSD values (in centimeters) in the right eye of patients with IIH was 0.57 ± 0.13, while it was 0.48 ± 0.03 in controls. In the left eye, the mean ONSD value (cm) was 0.59 ± 0.13 in patients with IIH and 0.48 ± 0.03 in controls. ONSD was significantly higher in cases compared to controls (P < 0.001, Welch test). Pulsatility index of the central retinal artery was significantly higher in cases compared to controls (P < 0.001, Welch test). Resistance index of the ophthalmic artery was statistically significant (P < 0.005, Welch test). Receiver operating characteristic curve analysis revealed a cutoff value of 5.1 mm on the right side and 5 mm on the left side had a sensitivity and specificity of more than 80% for IIH diagnosis. Conclusion Our study provides insights into the utility of optic nerve sheath measurements and arterial indices in the diagnosis of IIH in a South Indian cohort. Further research is needed to fully understand the longitudinal relationship of these parameters and treatment outcomes in IIH.
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Affiliation(s)
- KV Kishore
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ameya Patwardhan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - HR Aravinda
- Department of Neuroradiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Veerendrakumar Mustare
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Yu A, Zhu M, Chen C, Li Y, Cui H, Liu S, Zhao Q. Implantable Flexible Sensors for Health Monitoring. Adv Healthc Mater 2024; 13:e2302460. [PMID: 37816513 DOI: 10.1002/adhm.202302460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/05/2023] [Indexed: 10/12/2023]
Abstract
Flexible sensors, as a significant component of flexible electronics, have attracted great interest the realms of human-computer interaction and health monitoring due to their high conformability, adjustable sensitivity, and excellent durability. In comparison to wearable sensor-based in vitro health monitoring, the use of implantable flexible sensors (IFSs) for in vivo health monitoring offers more accurate and reliable vital sign information due to their ability to adapt and directly integrate with human tissue. IFSs show tremendous promise in the field of health monitoring, with unique advantages such as robust signal reading capabilities, lightweight design, flexibility, and biocompatibility. Herein, a review of IFSs for vital signs monitoring is detailly provided, highlighting the essential conditions for in vivo applications. As the prerequisites of IFSs, the stretchability and wireless self-powered properties of the sensor are discussed, with a special attention paid to the sensing materials which can maintain prominent biosafety (i.e., biocompatibility, biodegradability, bioresorbability). Furthermore, the applications of IFSs monitoring various parts of the body are described in detail, with a summary in brain monitoring, eye monitoring, and blood monitoring. Finally, the challenges as well as opportunities in the development of next-generation IFSs are presented.
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Affiliation(s)
- Aoxi Yu
- College of Electronic and Optical Engineering, and College of Flexible Electronics (Future Technology), Nanjing University of Posts and Telecommunications, 9 Wenyuan, Nanjing, 210023, P. R. China
| | - Mingye Zhu
- State Key Laboratory of Organic Electronics and Information Displays, and Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing, 210023, P. R. China
| | - Congkai Chen
- State Key Laboratory of Organic Electronics and Information Displays, and Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing, 210023, P. R. China
| | - Yang Li
- College of Electronic and Optical Engineering, and College of Flexible Electronics (Future Technology), Nanjing University of Posts and Telecommunications, 9 Wenyuan, Nanjing, 210023, P. R. China
| | - Haixia Cui
- State Key Laboratory of Organic Electronics and Information Displays, and Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing, 210023, P. R. China
| | - Shujuan Liu
- State Key Laboratory of Organic Electronics and Information Displays, and Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing, 210023, P. R. China
| | - Qiang Zhao
- College of Electronic and Optical Engineering, and College of Flexible Electronics (Future Technology), Nanjing University of Posts and Telecommunications, 9 Wenyuan, Nanjing, 210023, P. R. China
- State Key Laboratory of Organic Electronics and Information Displays, and Jiangsu Key Laboratory for Biosensors, Institute of Advanced Materials (IAM), Nanjing University of Posts and Telecommunications, 9 Wenyuan Road, Nanjing, 210023, P. R. China
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Patel S, Maria-Rios J, Parikh A, Okorie ON. Diagnosis and management of elevated intracranial pressure in the emergency department. Int J Emerg Med 2023; 16:72. [PMID: 37833652 PMCID: PMC10571389 DOI: 10.1186/s12245-023-00540-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Elevated intracranial pressure is a devastating complication of catastrophic brain injury. Intracranial hypertension is commonly seen in neurologic injury secondary to traumatic brain injuries. Uncontrolled pressures can lead to permanent neurologic damage, but acute medical management is often overlooked when pursuing surgical management options that may not always be indicated. DISCUSSION Traumatic brain injury is the leading cause of death in patients with severe neurologic injury. Diagnosing elevated intracranial pressures is imperative in initiating prompt treatment to reduce secondary central nervous system injury, morbidity, and mortality. Although the initial injury to the brain is typically irreversible, intracranial pressure control can assist in salvaging the remaining brain tissue from additional damage. We will discuss the initial medical and surgical management of traumatic brain injury to prevent further neurologic deterioration and reduce mortality. CONCLUSION Recent literature has reported several methods to detect elevated intracranial pressure easily and studies describing multiple treatment modalities. These investigations suggest that early detection and timely treatment of intracranial hypertension are beneficial in reducing mortality.
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Affiliation(s)
- Sima Patel
- Department of Critical Care Medicine, AdventHealth Orlando, 601 E Rollins St, Orlando, FL, 32803, USA.
| | - Jose Maria-Rios
- Department of Critical Care Medicine, AdventHealth Orlando, 601 E Rollins St, Orlando, FL, 32803, USA
| | - Amay Parikh
- Division of Neurocritical Care, Department of Critical Care Medicine, AdventHealth Orlando, 601 E Rollins St, Orlando, FL, 32803, USA
| | - Okorie Nduka Okorie
- Division of Neurocritical Care, Department of Critical Care Medicine, AdventHealth Orlando, 601 E Rollins St, Orlando, FL, 32803, USA
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Dias FA, Zotin MCZ, Alessio-Alves FF, Martins Filho RKDV, Barreira CMA, Vincenzi OC, Venturelli PM, Boulouis G, Goldstein JN, Pontes-Neto OM. Dilated optic nerve sheath by ultrasound predicts mortality among patients with acute intracerebral hemorrhage. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:861-867. [PMID: 37939718 PMCID: PMC10631847 DOI: 10.1055/s-0043-1775885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 07/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Intracerebral hemorrhage (ICH) is a deadly disease and increased intracranial pressure (ICP) is associated with worse outcomes in this context. OBJECTIVE We evaluated whether dilated optic nerve sheath diameter (ONSD) depicted by optic nerve ultrasound (ONUS) at hospital admission has prognostic value as a predictor of mortality at 90 days. METHODS Prospective multicenter study of acute supratentorial primary ICH patients consecutively recruited from two tertiary stroke centers. Optic nerve ultrasound and cranial computed tomography (CT) scans were performed at hospital admission and blindly reviewed. The primary outcome was mortality at 90-days. Multivariate logistic regression, ROC curve, and C-statistics were used to identify independent predictors of mortality. RESULTS Between July 2014 and July 2016, 57 patients were evaluated. Among those, 13 were excluded and 44 were recruited into the trial. Their mean age was 62.3 ± 13.1 years and 12 (27.3%) were female. On univariate analysis, ICH volume on cranial CT scan, ICH ipsilateral ONSD, Glasgow coma scale, National Institute of Health Stroke Scale (NIHSS) and glucose on admission, and also diabetes mellitus and current nonsmoking were predictors of mortality. After multivariate analysis, ipsilateral ONSD (odds ratio [OR]: 6.24; 95% confidence interval [CI]: 1.18-33.01; p = 0.03) was an independent predictor of mortality, even after adjustment for other relevant prognostic factors. The best ipsilateral ONSD cutoff was 5.6mm (sensitivity 72% and specificity 83%) with an AUC of 0.71 (p = 0.02) for predicting mortality at 90 days. CONCLUSION Optic nerve ultrasound is a noninvasive, bedside, low-cost technique that can be used to identify increased ICP in acute supratentorial primary ICH patients. Among these patients, dilated ONSD is an independent predictor of mortality at 90 days.
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Affiliation(s)
- Francisco Antunes Dias
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Maria Clara Zanon Zotin
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Medicina Interna, Divisão de Radiologia, Ribeirão Preto SP, Brazil.
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States.
| | - Frederico Fernandes Alessio-Alves
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Rui Kleber do Vale Martins Filho
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Clara Monteiro Antunes Barreira
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Otavio Costa Vincenzi
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Paula Muñoz Venturelli
- Universidad del Desarrollo, Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina, Centro de Estudios Clínicos, Santiago, Chile.
| | - Gregoire Boulouis
- Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States.
| | | | - Octavio Marques Pontes-Neto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
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Müller SJ, Henkes E, Gounis MJ, Felber S, Ganslandt O, Henkes H. Non-Invasive Intracranial Pressure Monitoring. J Clin Med 2023; 12:jcm12062209. [PMID: 36983213 PMCID: PMC10051320 DOI: 10.3390/jcm12062209] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/09/2023] [Accepted: 03/11/2023] [Indexed: 03/15/2023] Open
Abstract
(1) Background: Intracranial pressure (ICP) monitoring plays a key role in the treatment of patients in intensive care units, as well as during long-term surgeries and interventions. The gold standard is invasive measurement and monitoring via ventricular drainage or a parenchymal probe. In recent decades, numerous methods for non-invasive measurement have been evaluated but none have become established in routine clinical practice. The aim of this study was to reflect on the current state of research and shed light on relevant techniques for future clinical application. (2) Methods: We performed a PubMed search for “non-invasive AND ICP AND (measurement OR monitoring)” and identified 306 results. On the basis of these search results, we conducted an in-depth source analysis to identify additional methods. Studies were analyzed for design, patient type (e.g., infants, adults, and shunt patients), statistical evaluation (correlation, accuracy, and reliability), number of included measurements, and statistical assessment of accuracy and reliability. (3) Results: MRI-ICP and two-depth Doppler showed the most potential (and were the most complex methods). Tympanic membrane temperature, diffuse correlation spectroscopy, natural resonance frequency, and retinal vein approaches were also promising. (4) Conclusions: To date, no convincing evidence supports the use of a particular method for non-invasive intracranial pressure measurement. However, many new approaches are under development.
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Affiliation(s)
- Sebastian Johannes Müller
- Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
- Correspondence: ; Tel.: +49-(0)711-278-34501
| | - Elina Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
| | - Matthew J. Gounis
- New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, MA 01655, USA
| | - Stephan Felber
- Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Stiftungsklinikum Mittelrhein, D-56068 Koblenz, Germany
| | - Oliver Ganslandt
- Neurochirurgische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
| | - Hans Henkes
- Neuroradiologische Klinik, Klinikum Stuttgart, D-70174 Stuttgart, Germany
- Medizinische Fakultät, Universität Duisburg-Essen, D-47057 Duisburg, Germany
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Rodríguez Aparicio EE, Carrizosa Gonzalez JA, Rodriguez Lima DR. Optic nerve sheath diameter at high altitude: standardized measures in healthy volunteers. Ultrasound J 2022; 14:46. [PMCID: PMC9674817 DOI: 10.1186/s13089-022-00295-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/22/2022] [Indexed: 11/21/2022] Open
Abstract
Background Increases in the diameter of the optic nerve sheath (ONSD) on ultrasound are associated with high intracranial pressure (hICP). The normal value varies with altitude and the population studied. The objective of this study is to describe the normal values of the ONSD in a healthy adult population of the city of Bogotá, Colombia, at 2640 meters above sea level (masl). Patients and methods A prospective observational study was conducted on a total of 247 healthy individuals recruited from May 2021 to May 2022 who were subjected to the color, low power, optic disk, safety, elevated frequency, dual (CLOSED) protocol for measuring the bilateral ONSD adjusted to the eyeball transverse diameter (ETD). Results A total of 230 individuals were analyzed; the average ONSD of the right eye (RE) was 0.449 cm (range 0.288–0.7) and that of the left eye (LE) was 0.454 cm (range 0.285–0.698); the correlation between RE and LE was 0.93 (p < 0.005), and the correlation of the ONSD/ETD ratios for the RE and LE was lower (r2 = 0.79, p < 0.005). A total of 10.8% of the studied population had values greater than 0.55 cm. Conclusions The median ONSD and ONSD/ETD ratio in the city of Bogotá are similar to those described in other populations; however, approximately 10.8% of the healthy population may present higher values, which would limit the use of ONSD on its own for clinical decision-making, only repeated measurements with significant changes in the ONSD and ONSD/ETD or asymmetries between the measurements of both eyes linked to clinical findings would allow the diagnosis of hICP.
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Affiliation(s)
- Edith Elianna Rodríguez Aparicio
- grid.418089.c0000 0004 0620 2607Critical and Intensive Care Medicine Department, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia ,grid.412191.e0000 0001 2205 5940Faculty of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Jorge Armando Carrizosa Gonzalez
- grid.418089.c0000 0004 0620 2607Critical and Intensive Care Medicine Department, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - David Rene Rodriguez Lima
- Critical and Intensive Care Medicine, Hospital Universitario Mayor-Mederi, Bogotá, Colombia ,grid.412191.e0000 0001 2205 5940Grupo de Investigación Clínica, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
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The value of the optic nerve sheath diameter measured using computerized brain tomography in the evaluation of mortality status in patients admitted to the emergency department with intracranial hemorrhage. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.7410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background/Aim: The optic nerve sheath diameter (ONSD) measurement is a non-invasive method that can be obtained from computerized tomography (CT) images. It can therefore be a useful diagnostic tool in determining prognosis in the emergency department. The aim of this study was to investigate the relationship between ONSD and mortality status in patients with intracranial hemorrhage who presented to the emergency department by measuring ONSD on computerized brain tomography images taken during admission.
Methods: This retrospective cohort study was carried out in the emergency department of a tertiary hospital between December 1, 2018 and December 1, 2020 and included intracranial hemorrhage patients and patients with normal brain CT scans that had been obtained for any reason. Bilateral ONSDs were measured in both the intracranial hemorrhage and control groups. We first evaluated whether ONSD would differ between the two groups after which the relationship between ONSD and mortality was analyzed in the patient group who presented with bleeding.
Results: Intracranial hemorrhage was present in half the cases and midline shift in 21.5%. A statistically significant increase in ONSD was observed in cases with intracranial hemorrhage (P < 0.001). Similarly, a statistically significant increase in ONSD was found in cases with midline shifts and mortality (P < 0.001). A cut-off value of 4.19 mm for mean optic nerve diameter exhibited 100% sensitivity and 70% specificity in terms of hemorrhage detection (area under the curve [AUC]: 0.952; P < 0.001). A cut-off value of 6.03 mm for ONSD exhibited 76% sensitivity and 74% specificity in terms of hemorrhage detection (AUC: 0.730; P = 0.001). The odds ratio for prediction of mortality based on a regression analysis was 8.838 in cases with intracranial hemorrhage (P < 0.001).
Conclusion: ONSSD measured on CT images is a promising tool for prediction of intracranial hemorrhage, midline shift, and mortality status.
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Rosa N, De Bernardo M, Di Stasi M, Cione F, Capaldo I. A-Scan Ultrasonographic Evaluation of Patients with Idiopathic Intracranial Hypertension: Comparison of Optic Nerves. J Clin Med 2022; 11:jcm11206153. [PMID: 36294473 PMCID: PMC9605245 DOI: 10.3390/jcm11206153] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/12/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background: To evaluate the interocular optic nerve diameter (ONDs) asymmetry in patients with idiopathic intracranial hypertension (IIH) utilizing the A-scan ultrasound technique. Methods: Thirty-seven patients diagnosed with IIH were recruited from outpatients referred to the University Eye Unit between June 2014 and December 2021. Patients with optic disc pseudoedema or edema caused by other conditions were excluded. All patients with negative neuroimaging for intracranial space-occupying masses underwent standardized A-scan measurement of the OND in the primary gaze and lateral position (30 degrees test). Results: Mean, median, standard deviation, the minimum and maximum value of the two eyes at 0 degrees and the difference between the left and right thicker and thinner ONDs were measured. The two-tailed paired student t-test between the two eyes was performed using SPSS software. A statistically significant difference (p-value <0.001) between the two eyes, without a side prevalence, was found. Conclusions: Due to the differences between the ONDs of both eyes, we propose to use the mean of the ONDs between the left and right eyes at 0 degrees with the standardized A-scan diagnostic technique for a better follow-up of patients with IIH.
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Affiliation(s)
- Nicola Rosa
- Eye Unit, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, 84081 Salerno, Italy
| | - Maddalena De Bernardo
- Eye Unit, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, 84081 Salerno, Italy
- Correspondence: ; Tel.: +39-089672407
| | - Margherita Di Stasi
- Eye Unit, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, 84081 Salerno, Italy
| | - Ferdinando Cione
- Eye Unit, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, 84081 Salerno, Italy
| | - Ilaria Capaldo
- Radio Unit, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Via Salvador Allende, Baronissi, 84081 Salerno, Italy
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Wang Y, Yuan Z, Zhang Z, Shang J, Li M, Wang W. Lateral Ventricular Volume Asymmetry and Optic Nerve Sheath Diameter Predict Intracranial Pressure in Traumatic Brain Injury Patients. Appl Bionics Biomech 2022; 2022:9808334. [PMID: 35600847 PMCID: PMC9122704 DOI: 10.1155/2022/9808334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/21/2022] [Accepted: 04/19/2022] [Indexed: 11/17/2022] Open
Abstract
Background Various noninvasive methods of intracranial pressure (ICP) measurement have been proposed. Each has unique advantages and limitations. This study was aimed at investigating the relationships between lateral ventricular asymmetry on admission computed tomography, optic nerve sheath diameter (ONSD), and ICP in traumatic brain injury (TBI) patients. Methods A prospective observational study was conducted in the patients admitted to our department between October 2018 and October 2020. 20 patients with moderate-severe TBI with a Glasgow Coma Scale of 3-12 were enrolled. Lateral ventricle volume (LVV) value measurements were conducted using ITK-SNAP software. The lateral ventricular volume ratio (LVR) was quantified by dividing the larger LVV by the smaller. Results ONSD and LVR had a good correlation with ICP. Admission LVR of >1.735 was shown to have a sensitivity of 90.9% and a specificity of 88.9% for prediction of ICP increase (AUC = 0.879; standard error = 0.091; 95% CI = 0.701 to 1.0; significance level p < 0.004). Admission ONSD of >5.55 mm was shown to have a sensitivity of 81.8% and a specificity of 88.9% for prediction of ICP increase (AUC = 0.919; standard error = 0.062; 95% CI = 0.798 to 1.0; significance level p < 0.002). Combining the ONSD and LVR, the sensitivity could be improved to 90.9% in parallel test, and the specificity could be improved to 100% in serial test. Conclusion ONSD and LVR measurements can diagnose elevated ICP in traumatic brain injury patients. ONSD combining with LVR may further improve the diagnostic evaluation.
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Affiliation(s)
- Yang Wang
- Department of Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200030, China
| | - Ziming Yuan
- Department of Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200030, China
| | - Zuoyan Zhang
- Department of Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200030, China
| | - Jiawei Shang
- Department of Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200030, China
| | - Mingna Li
- Department of Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200030, China
| | - Wei Wang
- Department of Critical Care Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200030, China
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12
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Nerve optic segmentation in CT images using a deep learning model and a texture descriptor. COMPLEX INTELL SYST 2022. [DOI: 10.1007/s40747-022-00694-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractThe increased intracranial pressure (ICP) can be described as an increase in pressure around the brain and can lead to serious health problems. The assessment of ultrasound images is commonly conducted by skilled experts which is a time-consuming approach, but advanced computer-aided diagnosis (CAD) systems can assist the physician to decrease the time of ICP diagnosis. The accurate detection of the nerve optic regions, with drawing a precise slope line behind the eyeball and calculating the diameter of nerve optic, are the main aims of this research. First, the Fuzzy C-mean (FCM) clustering is employed for segmenting the input CT screening images into the different parts. Second, a histogram equalization approach is used for region-based image quality enhancement. Then, the Local Directional Number method (LDN) is used for representing some key information in a new image. Finally, a cascade Convolutional Neural Network (CNN) is employed for nerve optic segmentation by two distinct input images. Comprehensive experiments on the CT screening dataset [The Cancer Imaging Archive (TCIA)] consisting of 1600 images show the competitive results of inaccurate extraction of the brain features. Also, the indexes such as Dice, Specificity, and Precision for the proposed approach are reported 87.7%, 91.3%, and 90.1%, respectively. The final classification results show that the proposed approach effectively and accurately detects the nerve optic and its diameter in comparison with the other methods. Therefore, this method can be used for early diagnose of ICP and preventing the occurrence of serious health problems in patients.
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13
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Wang J, Yang M, Xu H, Huang C, Xia Z, Cheng Y, Shu X, Li Y, Shi B, Qin C, Xiao S, Liu M, Tang W. Diagnostic value of ONSD in sepsis associated encephalopathy of New Zealand rabbits. Brain Res Bull 2021; 179:68-73. [PMID: 34871709 DOI: 10.1016/j.brainresbull.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/07/2021] [Accepted: 12/02/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The purpose of the present study was to assess whether optic nerve sheath diameter (ONSD) measured by ultrasound could predict brain injury in sepsis associated encephalopathy (SAE). METHODS A total of 48 male New Zealand White rabbits were used to establish sepsis model. The levels of neuro-specific enolase (NSE), S100B, myeloperoxidase (MPO), and tumor necrosis factor-α (TNF-α) were detected by enzyme-linked immuno sorbent assay and ONSD were measured before modeling, 6 h, 12 h and 24 h after modeling. Sixteen rabbits were sacrificed for hematoxylin-eosin (HE) staining of brain tissue and the brain water content at above time points. Rabbits demonstrated brain injury by HE staining were included in the SAE group, the others were enrolled in the control group. The correlation between ONSD and MPO, NSE and S100B in the SAE group were analyzed. Receiver operator characteristic curves were generated to analyze the area under the curve (AUC), specificity and sensitivity of ONSD values for SAE. RESULTS Twenty-nine of 48 rabbits had brain injury, while 19 cases were enrolled in the control group. The level of MPO, NSE, S100B, TNF-α at 6 h, 12 h and 24 h in SAE group were all higher than those of the control group with statistical significance. The ONSD in SAE group increased with time and significantly wider than those in the control group. Correlation analysis revealed that ONSD was positively correlated with MPO, NSE and S100B in the SAE group. The AUCs for the ONSD value in diagnosing SAE at 6 h, 12 h and 24 h were 0.864, 0.957, 0.877, respectively. CONCLUSIONS Alterations in ONSD strongly correlated with MPO, NSE and S100B among SAE rabbits. Monitoring of ONSD exhibited a high predictive value for SAE.
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Affiliation(s)
- Jun Wang
- Department of Anesthesiology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Yang
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hui Xu
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chengjiao Huang
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhi Xia
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Cheng
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaolan Shu
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yong Li
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Buyun Shi
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chenguang Qin
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuna Xiao
- LiYuan Cardiovascular Center, Liyuan Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mei Liu
- Hospital Infection Management Department, Wuhan No.1 Hospital, Wuhan, China
| | - Wen Tang
- PICU, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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14
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Kamali A, Aein A, Naderi N, Choi SJ, Doyle N, Butler IJ, Huisman TAGM, Bonfante EE, Sheikh-Bahaei N, Khanpara S, Patel RP, Riascos RF, Zhang X, Tang RA, Radmanesh A. Neuroimaging Features of Intracranial Hypertension in Pediatric Patients With New-Onset Idiopathic Seizures, a Comparison With Patients with Confirmed Diagnosis of Idiopathic Intracranial Hypertension: A Preliminary Study. J Child Neurol 2021; 36:1103-1110. [PMID: 34747259 DOI: 10.1177/08830738211045234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A cutoff value of 6.0 mm for optic nerve sheath dilation may be used as a screening imaging marker to suspect elevated opening pressure with specificity of 88% in pediatric patients with new-onset idiopathic seizures.
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Affiliation(s)
- Arash Kamali
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Azin Aein
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Niyousha Naderi
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sally J Choi
- 12339University of Texas Medical School, Health Science Center at Houston, Houston, TX, USA
| | - Nathan Doyle
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ian J Butler
- Department of Pediatrics, Division of Pediatric Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Thierry A G M Huisman
- Departments of Pediatrics and Radiology, 3984Texas Children Hospital, 3989Baylor College of Medicine, Houston, TX, USA
| | - Eliana E Bonfante
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nasim Sheikh-Bahaei
- Department of Diagnostic Radiology, Division of Neuroradiology, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
| | - Shekhar Khanpara
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rajan P Patel
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Roy F Riascos
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xu Zhang
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rosa A Tang
- Department of Neurosurgery, Neuro-ophthalmology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alireza Radmanesh
- Department of Diagnostic Radiology, Division of Neuroradiology, 12297Langone Medical Center, New York University, New York, NY, USA
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15
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Zhu S, Cheng C, Zhao D, Zhao Y, Liu X, Zhang J. The clinical and prognostic values of optic nerve sheath diameter and optic nerve sheath diameter/eyeball transverse diameter ratio in comatose patients with supratentorial lesions. BMC Neurol 2021; 21:259. [PMID: 34215217 PMCID: PMC8252315 DOI: 10.1186/s12883-021-02285-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background The optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse diameter (ETD) ratio have been proven to be correlated with intracranial pressure. This study aimed to evaluate the prognostic roles of ONSD and the ONSD/ETD ratio in comatose patients with supratentorial lesions and to determine the relationship of these two indices with the prognosis of such patients. Methods A total of 54 comatose patients with supratentorial lesions and 50 healthy controls were retrospectively included in this study. ONSD and ETD were measured by unenhanced computed tomography (CT). The differences in ONSD and the ONSD/ETD ratio between the two groups were compared. The prognosis of comatose patients was scored using the Glasgow Outcome Scale (GOS) at the 3-month follow-up, and these patients were classified into good (GOS score ≥ 3) and poor (GOS score < 3) prognosis groups. The differences in ONSD and the ONSD/ETD ratio were compared between comatose patients with good prognoses and those with poor prognoses. Results The ONSD and ONSD/ETD ratios in the comatose patients were 6.30 ± 0.60 mm and 0.27 ± 0.03, respectively, and both were significantly greater than those in the healthy controls (5.10 ± 0.47 mm, t = 11.426, P < 0.0001; 0.22 ± 0.02, t = 11.468, P < 0.0001; respectively). ONSD in patients with poor prognosis was significantly greater than that in patients with good prognosis (6.40 ± 0.56 vs. 6.03 ± 0.61 mm, t = 2.197, P = 0.032). The ONSD/ETD ratio in patients with poor prognosis was significantly greater than that in patients with good prognosis (0.28 ± 0.02 vs. 0.26 ± 0.03, t = 2.622, P = 0.011). The area under the receiver operating characteristic (ROC) curve, used to predict the prognosis of comatose patients, was 0.650 (95% confidence interval (CI): 0.486–0.815, P = 0.078) for ONSD and 0.711 (95% CI: 0.548–0.874, P = 0.014) for the ONSD/ETD ratio. Conclusions The ONSD and ONSD/ETD ratios were elevated in comatose patients. The ONSD/ETD ratio might be more valuable than ONSD in predicting the prognoses of comatose patients with supratentorial lesions.
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Affiliation(s)
- Sha Zhu
- Department of Neurology, Peking University People's Hospital, No. 11 South Avenue, Xi Zhi Men Xicheng District, Beijing, 100044, China
| | - Chao Cheng
- Department of Radiology, Peking University International Hospital, Beijing, China
| | - Dianjiang Zhao
- Department of Radiology, Peking University International Hospital, Beijing, China
| | - Yuanli Zhao
- Department of Neurosurgery, Peking University International Hospital, Beijing, China.,Department of Neurosurgery, Beijing TianTan Hospital, Beijing, China
| | - Xianzeng Liu
- Department of Neurology, Peking University International Hospital, No. 1 Life Science Park Life Road, Changping District, Beijing, 102206, China.
| | - Jun Zhang
- Department of Neurology, Peking University People's Hospital, No. 11 South Avenue, Xi Zhi Men Xicheng District, Beijing, 100044, China.
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16
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Lateralization bias for autoimmune optic neuritis. Mult Scler Relat Disord 2021; 52:102980. [PMID: 33984650 DOI: 10.1016/j.msard.2021.102980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/02/2021] [Accepted: 04/22/2021] [Indexed: 11/23/2022]
Abstract
The asymmetrical structure of the human brain is reflected not only by innate interhemispheric differences but also by lateralization in neurological disease. We tested if unilateral autoimmune optic neuritis (aON) manifests more frequently on the left than the right eye in clinical and neuroimaging terms and whether Google searches for aON symptoms reflect this bias, too. We employed a retrospective analysis of a patient cohort from 2009 to 2019 with 552 unilateral aONs and 374 corresponding MRI imaging data sets. Searchmetrics Suite keywords tool was applied for the analysis of Google searches on aON-symptoms in Germany, the US and the UK for the last 12 months. Left eye aON manifestations were more frequent than right aON manifestations (55.3% vs. 44.7%, p = 0.015) and 1.9 times more likely to be associated with a pathological MRI finding in the affected optic nerve (p = 0.013). Keywords describing aON-typical but not other ocular symptoms were more frequently associated with Google searches for the left in comparison to the right eye (p < 0.001). Autoimmune optic neuritis more frequently affects the left than the right eye and people search on the Internet more often for left-sided aON symptoms. Although a reporting bias due to an increased perception of left eye symptoms is one possible explanation, MRI evidence of more frequent optic nerve affection for the left in comparison to the right side suggests a leftward lateralization bias similar to the one previously shown for cerebral neuroinflammatory lesions.
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17
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Razek AAKA, Elsaid N, Belal T, Batouty N, Azab A. Combined accuracy of optic nerve sheath diameter, strain ratio, and shear wave elastography of the optic nerve in patients with idiopathic intracranial hypertension. Ultrasonography 2021; 41:106-113. [PMID: 34218606 PMCID: PMC8696137 DOI: 10.14366/usg.20165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 04/20/2021] [Indexed: 11/03/2022] Open
Abstract
PURPOSE This study assessed the combined accuracy of optic nerve sheath diameter (ONSD), strain ratio (SR), and shear wave elastography (SWE) of the optic nerve (ON) in patients with idiopathic intracranial hypertension (IIH). METHODS This prospective study was carried out on both ONs of 34 consecutive patients diagnosed with IIH and 16 age- and sex-matched healthy volunteers. All of the study participants were women. The ONSD, SR, and SWE of the ON were measured. The severity of papilledema of IIH patients was sub-classified into mild papilledema and moderate/severe papilledema. RESULTS The mean ONSD (5.6±1.1 mm), SR (0.7±0.1), and SWE (30.1±16.7 kPa) of the IIH patients were significantly different (P=0.001) from the ONSD (4.1±0.5 mm), SR (0.9±0.1), and SWE (8.2±3.4 kPa) of controls. The cutoff values of ONSD, SR, and SWE of the ON for differentiating IIH patients from controls were 5.45 mm, 0.8, and 10.3 kPa with areas under the curve (AUCs) of 0.91, 0.86, and 0.96 and accuracy values of 91%, 81%, and 93%, respectively. Combined SWE and ONSD and combined SWE, ONSD, and SR for differentiating IIH patients from controls revealed AUCs of 0.98 and 0.99 and accuracy values of 96% and 96%, respectively. ONSD, SR, and SWE showed significant differences between mild and moderate/severe papilledema (P=0.001). Papilledema was correlated with SWE (r=0.8, P=0.001), ONSD (r=0.4, P=0.001), and SR (r=-0.4, P=0.001). CONCLUSION The combination of ONSD, SR, and SWE may be helpful for diagnosing IIH, and a good indicator of the degree of papilledema.
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Affiliation(s)
| | - Nada Elsaid
- Department of Neurology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Tamer Belal
- Department of Neurology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Nihal Batouty
- Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura, Egypt
| | - Ahmed Azab
- Department of Neurology, Mansoura Faculty of Medicine, Mansoura, Egypt
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18
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Is Optic Nerve Sheath Diameter a Reliable Proxy for Intracranial Pressure in Patients with Subarachnoid Hemorrhage? Neurocrit Care 2020; 33:617-618. [DOI: 10.1007/s12028-020-01038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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19
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Wach J, Hamed M, Schuss P, Güresir E, Herrlinger U, Vatter H, Schneider M. Impact of initial midline shift in glioblastoma on survival. Neurosurg Rev 2020; 44:1401-1409. [PMID: 32494988 DOI: 10.1007/s10143-020-01328-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/16/2020] [Accepted: 05/28/2020] [Indexed: 12/21/2022]
Abstract
The impact of midline shift (MLS) on long-term survival and progression in glioblastoma (GBM) is unknown. The objective of this study was to analyze the influence of mass effect on survival and progression with consideration of the patient demographics, tumor morphology, operative techniques, molecular pathology, and postoperative treatment. One hundred ninety-eight patients with GBM were analyzed retrospectively. Both MLS groups (< or ≥ 10 mm) were compared with regard to survival, progression-free survival (PFS), and postoperative course of Karnofsky Performance Status (KPS). A two-sided Fisher exact test showed no statistically significant differences in the confounders between the low- and high-MLS groups. The median survival was 18.0 months (95% confidence interval (CI) = 15.3-20.7) in the low-MLS group (n = 173) and 9.0 months (95% CI = 4.8-13.2) in the high-MLS group (n = 25) (p = 0.045). In the high-MLS group, 59.1% (13/22) with an initially high MLS had a KPS of less than 70% after 3 months, whereas 20.5% of the low-MLS group had a KPS of less than 70% (p < 0.001). Binary logistic regression analysis including the O-6-methylguanine-DNA methyltransferase (MGMT) status, extent of resection, baseline KPS, and MIB-I index showed low MLS as the only predictor for survival at 12 months (p = 0.046, odds ratio (OR) = 2.70, 95% CI = 1.0-7.2). Median PFS was 6.0 months in the high-MLS group and 9.0 months in the low-MLS group (log-rank test; p = 0.08). An initial midline shift of 10 mm or greater seems to be an imaging characteristic that independently predicts the survival in glioblastoma.
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Affiliation(s)
- Johannes Wach
- Department of Neurosurgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Motaz Hamed
- Department of Neurosurgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Ulrich Herrlinger
- Division of Clinical Neurooncology, Department of Neurology and Centre of Integrated Oncology, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Matthias Schneider
- Department of Neurosurgery, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
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20
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Meiburger KM, Naldi A, Michielli N, Coppo L, Fassbender K, Molinari F, Lochner P. Automatic Optic Nerve Measurement: A New Tool to Standardize Optic Nerve Assessment in Ultrasound B-Mode Images. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1533-1544. [PMID: 32147099 DOI: 10.1016/j.ultrasmedbio.2020.01.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/25/2020] [Accepted: 01/31/2020] [Indexed: 06/10/2023]
Abstract
Transorbital sonography provides reliable information about the estimation of intra-cranial pressure by measuring the optic nerve sheath diameter (ONSD), whereas the optic nerve (ON) diameter (OND) may reveal ON atrophy in patients with multiple sclerosis. Here, an AUTomatic Optic Nerve MeAsurement (AUTONoMA) system for OND and ONSD assessment in ultrasound B-mode images based on deformable models is presented. The automated measurements were compared with manual ones obtained by two operators, with no significant differences. AUTONoMA correctly segmented the ON and its sheath in 71 out of 75 images. The mean error compared with the expert operator was 0.06 ± 0.52 mm and 0.06 ± 0.35 mm for the ONSD and OND, respectively. The agreement between operators and AUTONoMA was good and a positive correlation was found between the readers and the algorithm with errors comparable with the inter-operator variability. The AUTONoMA system may allow for standardization of OND and ONSD measurements, reducing manual evaluation variability.
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Affiliation(s)
- Kristen M Meiburger
- PoliToBIOMed Lab, Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy.
| | - Andrea Naldi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Nicola Michielli
- PoliToBIOMed Lab, Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Lorenzo Coppo
- Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Klaus Fassbender
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Filippo Molinari
- PoliToBIOMed Lab, Biolab, Department of Electronics and Telecommunications, Politecnico di Torino, Turin, Italy
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
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21
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An update on idiopathic intracranial hypertension in adults: a look at pathophysiology, diagnostic approach and management. J Neurol 2020; 268:3249-3268. [PMID: 32462350 DOI: 10.1007/s00415-020-09943-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023]
Abstract
Idiopathic intracranial hypertension is a neurological syndrome determined by a rise in intracranial pressure without a detectable cause. Course and prognosis may be changeable, requiring a multidisciplinary approach for its diagnosis and management. Although its precise pathogenesis is still unknown, many studies have been carried out to define the possible causal and associated factors, such as retinoids, steroid hormones, body mass index and recent weight gains, cytokines and adipokines levels. The clinical presentation can be variable including chronic headache, disturbance of vision, diplopia and tinnitus. Even if papilloedema is considered the most specific sign, it could not be observed in more than 5% of patients during the evaluation of the fundus oculi. Neuroradiological signs acquire greater importance in patients who do not present papilloedema and may suggest the diagnosis of idiopathic intracranial hypertension. Other assessments can be useful in the diagnostic process, such as optical coherence tomography, visual evoked potentials, ocular ultrasonography and fundus fluorescein angiography and autofluorescence. Nonetheless, cerebrospinal fluid pressure measurement is required to establish a definite diagnosis. Management may be different, since surgical procedures or lumbar punctures are often required when symptoms develop rapidly leading to a loss of visual function. Apart from these cases, patients can be treated with a pharmacological approach and low-calorie diet, but they also need to be monitored over time since relapses years later are not uncommon.
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22
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Evensen KB, Eide PK. Measuring intracranial pressure by invasive, less invasive or non-invasive means: limitations and avenues for improvement. Fluids Barriers CNS 2020; 17:34. [PMID: 32375853 PMCID: PMC7201553 DOI: 10.1186/s12987-020-00195-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/19/2020] [Indexed: 12/20/2022] Open
Abstract
Sixty years have passed since neurosurgeon Nils Lundberg presented his thesis about intracranial pressure (ICP) monitoring, which represents a milestone for its clinical introduction. Monitoring of ICP has since become a clinical routine worldwide, and today represents a cornerstone in surveillance of patients with acute brain injury or disease, and a diagnostic of individuals with chronic neurological disease. There is, however, controversy regarding indications, clinical usefulness and the clinical role of the various ICP scores. In this paper, we critically review limitations and weaknesses with the current ICP measurement approaches for invasive, less invasive and non-invasive ICP monitoring. While risk related to the invasiveness of ICP monitoring is extensively covered in the literature, we highlight other limitations in current ICP measurement technologies, including limited ICP source signal quality control, shifts and drifts in zero pressure reference level, affecting mean ICP scores and mean ICP-derived indices. Control of the quality of the ICP source signal is particularly important for non-invasive and less invasive ICP measurements. We conclude that we need more focus on mitigation of the current limitations of today's ICP modalities if we are to improve the clinical utility of ICP monitoring.
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Affiliation(s)
- Karen Brastad Evensen
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, P.O. Box 4950, Nydalen, 0424, Oslo, Norway
- Department of Informatics, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Per Kristian Eide
- Department of Neurosurgery, Oslo University Hospital-Rikshospitalet, P.O. Box 4950, Nydalen, 0424, Oslo, Norway.
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
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