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Verma D, Sadayandi RA, Anbazhagan S, Nagarajan K, Bidkar PU. Is optic nerve sheath diameter a promising screening tool to predict neurological outcomes and the need for secondary decompressive craniectomy in moderate to severe head injury patients? A prospective monocentric observational pilot study. Surg Neurol Int 2023; 14:276. [PMID: 37680910 PMCID: PMC10481796 DOI: 10.25259/sni_318_2023] [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: 04/10/2023] [Accepted: 07/24/2023] [Indexed: 09/09/2023] Open
Abstract
Background Optic nerve sheath diameter (ONSD) has been shown to be a noninvasive and quick method to calculate intracranial pressure (ICP) and subsequent neurologic outcomes, although with variable cutoffs. ICP can be indirectly assessed by noninvasive methods such as transcranial Doppler, ONSD, tympanic membrane displacement, and fundoscopy. Knowledge regarding the diagnostic accuracy of ONSD for predicting unfavorable outcomes within 72 hours (h) of moderate and severe head injury is limited. The objective of this study was to measure ONSD measurements at 24-h intervals in moderate to severe head injury patients and to find its association with clinical outcomes in the target population. Methods This prospective observational study was done on moderate to severe head injury patients. ONSD was measured twice at 24-h intervals over 48 h. The clinical outcome was divided into the favorable group (patients who were in conservative treatment with a stable Glasgow Coma Scale [GCS] score and discharged following treatment) and the unfavorable group (patients who had a drop in GCS motor score of one or more, or expired or underwent surgical intervention) within 72 h following traumatic brain injury. The Kruskal-Wallis test, Mann- Whitney test, and receiver operating characteristic curves were used to establish the association between ONSD and clinical outcomes. Results ONSD values measured at 24-h intervals >6.1 mm (P < 0.0146) and 6.2 mm (P < 0.0001) were found to be predictors of unfavorable outcomes (expired or underwent surgery), and hence the need for a secondary decompressive craniectomy (DC). Conclusion ONSD is an efficient screening tool to assess neurological outcomes in severe head injury patients. It can reliably predict the need for secondary DC at an earlier stage before secondary brain damage ensues in these patients.
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Affiliation(s)
- Dinesh Verma
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ramesh Andi Sadayandi
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sathiaprabhu Anbazhagan
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Krishnan Nagarajan
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Prasanna Udupi Bidkar
- Department of Anaesthesiology and Critical Care, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Batur A, Karaca MA, Arslan V, Boz M, Ibrahimov Z, Erbil B, Onur MR. Prognostic role of optic nerve sheath diameter in stroke in emergency department, A case control study. Niger J Clin Pract 2023; 26:863-870. [PMID: 37635568 DOI: 10.4103/njcp.njcp_1770_21] [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] [Indexed: 08/29/2023]
Abstract
Background Sonographic measurement of optic nerve sheath diameter (ONSD) can reflect intracranial pressure (ICP) indirectly and determine the neurology intensive care unit (NICU) requirement and mortality in acute ischemic stroke (AIS). Aim To demonstrate the effectiveness of ONSD to determine mortality, morbidity, and NICU requirement on patients with the AIS. Methods The sonographic ONSD measurements were performed on each patient with AIS, over 18 years old. All patients were categorized according to the Oxfordshire Community Stroke Project (OCSP) classification system. MRI images were examined for increased ICP, and the patients were categorized into two groups as increased ICP (i-ICP) and normal ICP. The ONSD results were evaluated in terms of classifications, outcomes, and prognosis of the patients. Results One hundred and five patients were included and 31 (35.2%) were in the i-ICP group. The median ONSDs were 5.26 mm in the i-ICP group and 4.62 mm in the normal ICP group (P < 0.001). The median ONSDs were 5.13 mm in the NICU group and 4.69 mm in the neurology ward (NW) group (P = 0.001). The total anterior circulation infarction (TACI) subgroup had higher ONSDs than the others (TACI: 5.27 mm; PACI: 4.73 mm; POCI: 4.77 mm; and LACI: 4.64 mm, P < 0.001). The NICU requirements were higher in the TACI subgroup. The median ONSD was 5.42 mm in the deceased group (survived: 4.77 mm, P < 0.001). Conclusion ONSD may be favorable for predicting the increased ICP and the NICU requirement in OCSP subgroups. Moreover, ONSD can be used to foresee the mortality of AIS.
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Affiliation(s)
- A Batur
- Department of Emergency Medicine, Hacettepe University, Faculty of Medicine, 06120 Altindag Ankara, Turkey
| | - M A Karaca
- Department of Emergency Medicine, Hacettepe University, Faculty of Medicine, 06120 Altindag Ankara, Turkey
| | - V Arslan
- Department of Emergency Medicine, Hacettepe University, Faculty of Medicine, 06120 Altindag Ankara, Turkey
| | - M Boz
- Department of Emergency Medicine, Hacettepe University, Faculty of Medicine, 06120 Altindag Ankara, Turkey
| | - Z Ibrahimov
- Department of Emergency Medicine, Hacettepe University, Faculty of Medicine, 06120 Altindag Ankara, Turkey
| | - B Erbil
- Department of Emergency Medicine, Hacettepe University, Faculty of Medicine, 06120 Altindag Ankara, Turkey
| | - M R Onur
- Radiology, Hacettepe University, Faculty of Medicine, 06120 Altindag Ankara, Turkey
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Rajaei F, Cheng S, Williamson CA, Wittrup E, Najarian K. AI-Based Decision Support System for Traumatic Brain Injury: A Survey. Diagnostics (Basel) 2023; 13:diagnostics13091640. [PMID: 37175031 PMCID: PMC10177859 DOI: 10.3390/diagnostics13091640] [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: 03/28/2023] [Revised: 04/22/2023] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
Traumatic brain injury (TBI) is one of the major causes of disability and mortality worldwide. Rapid and precise clinical assessment and decision-making are essential to improve the outcome and the resulting complications. Due to the size and complexity of the data analyzed in TBI cases, computer-aided data processing, analysis, and decision support systems could play an important role. However, developing such systems is challenging due to the heterogeneity of symptoms, varying data quality caused by different spatio-temporal resolutions, and the inherent noise associated with image and signal acquisition. The purpose of this article is to review current advances in developing artificial intelligence-based decision support systems for the diagnosis, severity assessment, and long-term prognosis of TBI complications.
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Affiliation(s)
- Flora Rajaei
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Shuyang Cheng
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Craig A Williamson
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI 48109, USA
| | - Emily Wittrup
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kayvan Najarian
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI 48109, USA
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI 48109, USA
- Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI 48109, USA
- Center for Data-Driven Drug Development and Treatment Assessment (DATA), University of Michigan, Ann Arbor, MI 48109, USA
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Krueger EM, Benveniste RJ, Taylor RR, Shah S, Moll J, Figueroa JM, Jagid JR. Neurologic Outcomes for Octogenarians Undergoing Emergent Surgery for Traumatic Acute Subdural Hematoma. World Neurosurg 2023; 171:e404-e411. [PMID: 36521754 DOI: 10.1016/j.wneu.2022.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Determining the appropriate surgical indications for obtunded octogenarians with traumatic acute subdural hematoma (aSDH) has been challenging. We sought to determine which easily available data would be useful adjuncts to assist in early and quick decision-making. METHODS We performed a single-center, retrospective review of patients aged ≥80 years with confirmed traumatic aSDH who had undergone emergent surgery. The clinical measurements included the Karnofsky performance scale score, Charlson comorbidity index, Glasgow coma scale (GCS), and abbreviated injury score. The radiographic measurements included the Rotterdam computed tomography score, aSDH thickness, midline shift, and optic nerve sheath diameter (ONSD). The neurologic outcomes were defined using the extended Glasgow outcome scale-extended (GOS-E) at hospital discharge and 3-month follow-up. The Pearson correlation coefficient was used to compare the ONSD with all clinical, radiographic, and outcome variables. Multivariate logistic regression was used to assess the relationship between the discharge and 3-month GOS-E scores between all clinical and radiographic variables. RESULTS A total of 17 patients met the inclusion criteria. The mean age was 82.5 ± 1.6 years (range, 80-85 years), and the mean GCS score was 11.2 ± 4.1 (range, 4-15). The mean discharge and 3-month GOS-E scores were 3.4 ± 2.6 (range, 1-8) and 2.3 ± 2.1 (range, 1-7), respectively. We found significant negative correlations between the ONSD and the GCS score (r = -0.62; P < 0.01) and the ONSD and discharge GOS-E score (r = -0.49; P = 0.05). Multivariate analysis revealed a significant association between the abbreviated injury score and the discharge GOS-E score (P = 0.05). CONCLUSIONS Octogenarians sustaining aSDH and requiring emergent surgery have poor outcomes. More data are needed to determine whether the ONSD can be a useful adjunct tool to predict the efficacy of emergent surgery.
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Affiliation(s)
- Evan M Krueger
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Ronald J Benveniste
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ruby R Taylor
- Univeristy of Miami Miller School of Medicine, Miami, Florida USA
| | - Sumedh Shah
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joshua Moll
- Univeristy of Miami Miller School of Medicine, Miami, Florida USA
| | - Javier M Figueroa
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jonathan R Jagid
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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Gültekin H, Güven M. Optic nerve sheath diameter, intensive care unit admission and COVID-19-related-in-hospital mortality. QJM 2023; 116:107-113. [PMID: 36259936 PMCID: PMC9619847 DOI: 10.1093/qjmed/hcac242] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/10/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Hypoxia and hypercapnia due to acute pulmonary failure in patients with coronavirus disease 2019 (COVID-19) can increase the intracranial pressure (ICP). ICP correlated with the optic nerve sheath diameter (ONSD) on ultrasonography and is associated with a poor prognosis. AIM We investigated the capability of ONSD measured during admission to the intensive care unit (ICU) in patients with critical COVID-19 in predicting in-hospital mortality. METHODS A total of 91 patients enrolled in the study were divided into two groups: survivor (n = 48) and nonsurvivor (n = 43) groups. ONSD was measured by ultrasonography within the first 3 h of ICU admission. RESULTS The median ONSD was higher in the nonsurvivor group than in the survivor group (5.95 mm vs. 4.15 mm, P < 0.001). The multivariate Cox proportional hazard regression analysis between ONSD and in-hospital mortality (contains 26 covariates) was significant (adjusted hazard ratio, 4.12; 95% confidence interval, 1.46-11.55; P = 0.007). The ONSD cutoff for predicting mortality during ICU admission was 5 mm (area under the curve, 0.985; sensitivity, 98%; and specificity, 90%). The median survival of patients with ONSD >5 mm (43%; n = 39) was lower than those with ONSD ≤5 mm (57%; n = 52) (11.5 days vs. 13.2 days; log-rank test P = 0.001). CONCLUSIONS ONSD ultrasonography during ICU admission may be an important, cheap and easy-to-apply method that can be used to predict mortality in the early period in patients with critical COVID-19.
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Affiliation(s)
- Hamza Gültekin
- Şırnak State Hospital, Department of Intensive Care Unit, 73000, Şırnak, Turkey
| | - Mehmet Güven
- Şırnak State Hospital, Department of Endocrinology and Metabolism, 73000, Şırnak, Turkey
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Fujiwara G, Murakami M, Maruyama D, Murakami N. Optic nerve sheath diameter as a quantitative parameter associated with the outcome in patients with traumatic brain injury undergoing hematoma removal. Acta Neurochir (Wien) 2023; 165:281-287. [PMID: 36602615 DOI: 10.1007/s00701-022-05479-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE To determine the association between optic nerve sheath diameter (ONSD) and outcome in patients with traumatic brain injury (TBI) who undergo hematoma removal (HR). METHODS This study was a retrospective analysis of data from a single center between 2016 and 2021. Adult patients with TBI who underwent HR within 24 h after admission were included in this study. Preoperative and postoperative ONSD of the surgical side and the mean ONSD of both sides were measured for analysis. The primary outcome was mortality at 30 days. Receiver operating characteristic curve analysis was performed to calculate the area under the curve (AUC) and 95% confidence interval (CI) for 30 days mortality. RESULTS Sixty-one patients were enrolled in the study. Among them, 48 (78.7%) survived for 30 days after admission. The AUC and 95% CI of the postoperative mean ONSD on both sides and postoperative/preoperative mean of the ONSD ratio on both sides were 0.884 [0.734-0.955] and 0.875 [0.751-0.942], respectively. The postoperative mean of both ONSDs of 6.0 mm had high accuracy as a cut-off value with a sensitivity of 85%, specificity of 83%, positive likelihood ratio (LR) of 5.0, and negative LR- of 0.18. CONCLUSION This study demonstrated that postoperative ONSD and the postoperative/preoperative ONSD ratio were associated with postoperative outcome in patients with TBI who underwent HR.
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Affiliation(s)
- Gaku Fujiwara
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc, 2-4-1, Ohashi, Ritto, Shiga, 520-3046, Japan. .,Department of Neurosurgery, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan.
| | - Mamoru Murakami
- Department of Neurosurgery, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan.,Department of Neurosurgery, Kyoto Tanabe Central Hospital, Kyoto, Japan
| | - Daisuke Maruyama
- Department of Neurosurgery, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan.,Department of Neurosurgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nobukuni Murakami
- Department of Neurosurgery, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan
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7
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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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Suresh V, Ushakumari PR, Aggarwal A, Kumar A, Kutty RK, Prabhakar RB, Peethambaran A. Perioperative Variation in Optic Nerve Sheath Diameter - A Prospective Observational Study of Traumatic Brain Injury Patients Undergoing Decompressive Craniectomy. Neurol India 2022; 70:1460-1467. [PMID: 36076644 DOI: 10.4103/0028-3886.355178] [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] [Indexed: 11/04/2022]
Abstract
Background Measuring optic nerve sheath diameter (ONSD) by transbulbar ultrasonography (TBUS) can suffice non-invasive ICP measurement with considerable accuracy. Objective The primary objective of this study was to evaluate the perioperative variation in ONSD by TBUS in Traumatic Brain Injury (TBI) patients undergoing emergency craniectomy. Methods We prospectively compared bilateral ONSD measurements in 45 consecutive TBI cases undergoing decompressive craniectomy under general anesthesia; before and after surgery. A total of 180 ONSD images were obtained and measurements were done by the same investigator blinded to the pre/postoperative nature of the image. Results Based on preoperative Glasgow Coma Scores, 34 cases (75.5%) had severe TBI; 10 cases (22.2%) moderate TBI; and 1 case (2.2%) mild TBI. Preoperative ONSD in the study population were as 6.625 ± 0.414mm. Average ONSD reduced significantly by 0.249 ± 0.148 mm (P < 0.001) after craniectomy. On pooled analysis of cases undergoing right versus left sided craniectomy average ONSD reduced significantly by 0.252 ± 0.173 mm (P < 0.001) and 0.259 ± 0.139 mm (P < 0.001), respectively. ONSD of right eye with left eye and vice-versa were strongly correlated both pre/postoperatively with Pearson correlation coefficients (r)=0.879 (P < 0.001) and r = 0.827 (P < 0.001), respectively. Conclusions In TBI cases undergoing decompressive craniectomy ONSD is bilaterally increased preoperatively. ONSD reduces significantly immediately after craniectomy; however, the diameters did not near the normal range. There hold a strong correlation between right/left ONSD measurements irrespective of the laterality of injury or side of surgery. Variable elastic properties of ONS in an injured brain can possibly explain our findings.
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Affiliation(s)
- Varun Suresh
- Department of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - P R Ushakumari
- Department of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Anurag Aggarwal
- Department of Neuroanesthesia and Pain Medicine, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Arun Kumar
- Department of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Raja K Kutty
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Rajmohan B Prabhakar
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Anilkumar Peethambaran
- Department of Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India
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Optic Nerve Sheath Diameter for Predicting Outcomes in Post-Cardiac Arrest Syndrome: An Updated Systematic Review and Meta-Analysis. J Pers Med 2022; 12:jpm12030500. [PMID: 35330499 PMCID: PMC8953152 DOI: 10.3390/jpm12030500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 02/01/2023] Open
Abstract
We aimed to identify the efficacy of optic nerve sheath diameter (ONSD) in predicting mortality and poor neurological outcomes (PNO) in post-cardiac arrest syndrome (PCAS) by the measurement time of outcomes. We conducted an extensive literature search in EMBASE, MEDLINE, and Cochrane Library, which included studies on the prognostic accuracy of ONSD in predicting PNO and mortality in PCAS by the measured time of outcomes. A total of 791 patients from nine studies were included. Increased ONSD was weakly associated with PNO by a high heterogeneity (standardized mean difference with 95% confidence interval = 0.74 (0.22, 1.27); I2 = 87%). The analysis by the measurement time of PNO and mortality for ONSD had no significant difference due to insufficient articles or high heterogeneities. The prognostic accuracy of ONSD was 23.97 (pooled diagnostic odds ratio, I2 = 0%) and 0.94 (area under the curve) for short-term PNO. The pooled results showed low or very low quality and very low quality of evidence for PNO and mortality, respectively. ONSD measurement might be an effective predictor for short-term PNO in PCAS. An analysis by measurement time of outcomes showed no significant evidence for ONSD measurement effectiveness in predicting mortality and PNO.
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Yavaşi Ö, Metin NO, Metin Y, Çelik A, Tüfekçi A, Çeliker FB. The role of optic nerve sheath diameter measurement on CT in differentiating transient ischemic attack and acute ischemic stroke. Clin Neurol Neurosurg 2021; 212:107094. [PMID: 34952365 DOI: 10.1016/j.clineuro.2021.107094] [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: 10/04/2021] [Revised: 11/14/2021] [Accepted: 12/14/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to determine if optic nerve sheath diameter (ONSD) measurement on computed tomography could differentiate transient ischemic attack (TIA) from acute ischemic stroke (AIS). Both TIA and AIS are the rings of the same disease chain. To exclude hemorrhagic stroke and stroke mimics in these patients, brain computed tomography (CT) remains the first step imaging modality. PATIENTS AND METHODS In this retrospective study, ONSDs of patients with TIA and AIS within three hours from symptom onset to initial CT was measured. The right, left, mean, and delta ONSD measurements were compared between AIS and TIA groups. Then diagnostic accuracy metrics were calculated. RESULTS A total of 196 patients (128 in the AIS group and 68 in the TIA group) were included. Both mean and delta ONSD of AIS patients were higher than those of the TIA group. The area under the receiver operating curve of mean and delta ONSD for predicting AIS were 0.746 with a sensitivity of 82.8% and a specificity of 42.7% (cut-off: 5.00 mm), and 0.826 with a sensitivity of 67.2% and a specificity of 86.8% (cut-off: 0.50 mm), respectively. CONCLUSION Increased mean or delta ONSD measured on initial CT could alert emergency physicians for an impending stroke.
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Affiliation(s)
- Özcan Yavaşi
- Department of Emergency Medicine, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey.
| | - Nurgül Orhan Metin
- Department of Radiology, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey; Department of Radiology, Beytepe Murat Erdi Eker State Hospital, Ankara, Turkey.
| | - Yavuz Metin
- Department of Radiology, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey; Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey.
| | - Ali Çelik
- Department of Emergency Medicine, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey.
| | - Ahmet Tüfekçi
- Department of Neurology, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey.
| | - Fatma Beyazal Çeliker
- Department of Radiology, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey.
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11
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Natile M, Simonet O, Vallot F, De Kock M. Ultrasound measurement of the optic nerve sheath diameter in traumatic brain injury: a narrative review. ACTA ANAESTHESIOLOGICA BELGICA 2021. [DOI: 10.56126/72.4.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background : Raised intracranial pressure (ICP) needs to be investigated in various situations, especially in traumatic brain injury (TBI). Ultra-sonographic (US) measurement of the optic nerve sheath diameter (ONSD) is a promising noninvasive tool for assessing elevated ICP.
Objectives : This narrative review aimed to explain the history of and indications forUS measurement of ONSD. We focused on the detection of elevated ICP after TBI and discussed the possible improvements in detection methods.
Conclusions : US measurement of ONSD in TBI cases provides a qualitative but no quantitative assessment of ICP. Current studies usually calculate their own optimum cutoff value for detecting raised ICP based on the balance between sensitivity and specificity of the method when compared with invasive methods. There is no universally accepted threshold. We did not find any paper focusing on the prognosis of patients benefiting from it when compared with usual care. Another limitation is the lack of standardization. US measurement of ONSD cannot be used as the sole technique to detect elevated ICP and monitor its evolution, but it can be a useful tool in a multimodal protocol and it might help to determine the prognosis of patients in various situations.
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12
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McLaughlin D, Anderson L, Guo J, McNett M. Serial Optic Nerve Sheath Diameter via Radiographic Imaging: Correlation With ICP and Outcomes. Neurol Clin Pract 2021; 11:e620-e626. [PMID: 34840875 DOI: 10.1212/cpj.0000000000001038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/06/2020] [Indexed: 12/20/2022]
Abstract
Objective Evaluation of optic nerve sheath diameter (ONSD) is a suggested correlation of intracranial pressure (ICP) and potential predictor of outcome after neurologic injury. Studies have evaluated sonographic measurement of ONSD; however, clinical limitations to this approach persist. Evaluation of ONSD measurements via routine brain CT imaging is less studied but offers potential for detection of increased ICP in the absence of invasive monitoring. Previous studies have used cross-sectional approaches to ONSD measurements via CT scan among patients with traumatic brain injury (TBI). No studies have evaluated serial correlations between CT ONSD measurements and ICP throughout hospitalization and across diagnosis types. The objective of this study was to investigate correlations between ONSD via serial CT imaging, ICP, and outcome at discharge among patients with neurologic injury. Methods This is a retrospective cohort study of all adult patients admitted during a 12-month period with acute neurologic injury requiring ICP monitoring and critical care admission. Results N = 48. There was a strong, positive correlation between right/left ONSD across time points (r = 0.7-9, p < 0.001), suggesting a consistent bilateral response. Correlations were strongest between initial inpatient CT scan ONSD readings and ICP (r = 0.5, p < 0.05), but decreased over time. Patients with increased ICP across all diagnosis types experienced higher ONSD values on presentation to the emergency department (ED) and throughout hospitalization (range 5.7-6.4 mm, p < 0.05). Conclusions Findings contribute to the utility of CT ONSD measurements as a potential indicator of increased ICP. Measurement of ONSD during serial CT brain imaging may inform clinical decisions regarding need for more invasive monitoring after neurologic injury.
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Affiliation(s)
- Diane McLaughlin
- Department of Critical Care (DM), Mayo Clinic, Jacksonville, FL; Department of Neurosurgery MetroHealth (LA), Cleveland; Ohio State University (JG); and The Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare (MM), Ohio State University, Columbus
| | - Lisa Anderson
- Department of Critical Care (DM), Mayo Clinic, Jacksonville, FL; Department of Neurosurgery MetroHealth (LA), Cleveland; Ohio State University (JG); and The Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare (MM), Ohio State University, Columbus
| | - Jinhong Guo
- Department of Critical Care (DM), Mayo Clinic, Jacksonville, FL; Department of Neurosurgery MetroHealth (LA), Cleveland; Ohio State University (JG); and The Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare (MM), Ohio State University, Columbus
| | - Molly McNett
- Department of Critical Care (DM), Mayo Clinic, Jacksonville, FL; Department of Neurosurgery MetroHealth (LA), Cleveland; Ohio State University (JG); and The Helene Fuld Health Trust National Institute for Evidence-Based Practice in Nursing and Healthcare (MM), Ohio State University, Columbus
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13
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Onder H, Goksungur G, Eliacik S, Ulusoy EK, Arslan G. The significance of ONSD, ONSD/ETD ratio, and other neuroimaging parameters in idiopathic intracranial hypertension. Neurol Res 2021; 43:1098-1106. [PMID: 34409925 DOI: 10.1080/01616412.2021.1949688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: The measurement of the optic nerve sheath diameter (ONSD) has been suggested to be used in the evaluation of intracranial pressure of several etiologies. However, its potential utility in the clinical evaluation of patients with idiopathic intracranial hypertension (IIH) needs to be clarified.Methods: We recruited all the IIH patients who had been admitted to our neurology clinics and had a cranial MRI before lumbar puncture investigation. A control group of patients with migraine was also included. Studies were reviewed blindly by a radiologist, and ONSD and ONSD/ eyeball transverse diameter (ETD) for both eyes were measured.Results: Ultimately, we have enrolled 50 patients with IIH and 53 migraineurs. The right ONSD values were higher in the IIH group (p = 0.024) whereas the values of ONSD/ETD were found to be both higher in the IIH group (right: p = 0.006, left: p = 0.043). The ROC curve demonstrated an area under the curve of 0.620 (95% CI = 0.508 to 0.731) for ONSD, and it was 0.642 for ONSD/ETD. Using a cut-off of 6.3 mm, ONSD had the following performance characteristics: sensitivity 18%, specificity 81%.Conclusions: The ONSD and ONSD/ETD values may be utilizable in the evaluation processes of IIH patients; however, they do not solely reach sufficient discriminative accuracy. The potential significance of these parameters in rather monitoring the IIH patients may constitute a strictly crucial topic of interest for future research.
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Affiliation(s)
- Halil Onder
- Department of Neurology, Yozgat City Hospital, Yozgat, Turkey
| | - Gurol Goksungur
- Department of Radiology, Bozok University Medical School, Yozgat, Turkey
| | - Sinan Eliacik
- Department of Neurology, Hitit University-Corum Erol Olcok Training and Research Hospital, Corum, Turkey
| | | | - Guven Arslan
- Department of Neurology, Kayseri City Hospital, Kayseri, Turkey
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14
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Yilmaz IO, Aksay E, Bayram B, Oray NC, Karabay N. Interrater reliability of emergency medicine residents in measurement of optic nerve sheath diameter with computed tomography. Turk J Emerg Med 2021; 21:117-121. [PMID: 34377868 PMCID: PMC8330611 DOI: 10.4103/2452-2473.320805] [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: 12/31/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES: Many studies have recently been conducted on measuring optic nerve sheath diameter (ONSD) with computed tomography (CT). However, no studies focused on the interrater reliability in ONSD measurements with CT yet. Our first aim was to investigate the interrater reliability of the emergency medicine residents in the measurement of the ONSD with CT. Our secondary aim was to evaluate the interrater reliability and agreement of the emergency medicine residents and neuroradiologist measurements, which is the gold standard. METHODS: Twelve residents (six seniors and six juniors) and a neuroradiologist measured ONSD in twenty different CTs in axial and sagittal planes. The interrater reliability was calculated by the intraclass correlation coefficient (ICC), and the level of agreement in categorical variables was calculated by kappa (ĸ) analysis. RESULTS: We found that the interrater reliability level of all residents was “good” (ICC: 0.824), for seniors was “good” (ICC: 0.824), and for juniors was “moderate” (ICC: 0.748) in the measurement of ONSD. ICC was 0.812 for axial, and 0.783 for sagittal plane measurements. The interrater reliability between residents and the neuroradiologist measurements was “good” (ICC 0.891), and the agreement was found to be “good” (ĸ: 0.688; P < 0.001). The sensitivity of residents in detecting increased ONSD was 78%, and specificity was 90.8%. CONCLUSION: The ONSD measurements with CT performed by the residents are reliable in themselves, and they are compatible with the gold standard measurements.
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Affiliation(s)
- Irem Olcay Yilmaz
- Department of Emergency Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Ersin Aksay
- Department of Emergency Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Basak Bayram
- Department of Emergency Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Nese Colak Oray
- Department of Emergency Medicine, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Nuri Karabay
- Department of Radiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey
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15
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Şık N, Erbaş İM, Demir K, Yılmaz D, Duman M. Bedside sonographic measurements of optic nerve sheath diameter in children with diabetic ketoacidosis. Pediatr Diabetes 2021; 22:618-624. [PMID: 33538381 DOI: 10.1111/pedi.13188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/19/2021] [Accepted: 01/29/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Bedside sonographic assessment of the optic nerve sheath has gained popularity for evaluating intracranial pressure in recent years. OBJECTIVE To investigate the bedside sonographic measurements of optic nerve sheath diameter (ONSD) and ONSD/eyeball diameter ratios, which are related with cerebral edema (CE), in children with diabetic ketoacidosis (DKA) before and after treatment. METHODS Children aged 12 months to 18 years, who were diagnosed with DKA were included. The ONSD was measured at 3 mm posterior to the globe in the anterior axial transbulbar view. The eyeball transverse diameter (ETD) and eyeball vertical diameter (EVD) were measured and ratios of ONSD/ETD and ONSD/EVD were calculated. Bedside ultrasound (US) examinations were performed at the beginning and at the end of fluid therapy. RESULTS About 43 patients were enrolled. About 12 (27.9%) patients had mild, 14 (32.6%) moderate, and 17 (39.5%) severe DKA. At baseline, the ONSD measurements and ratios were significantly higher in severe DKA group than in those with mild or moderate DKA group. All ONSD measurements, ONSD/ETD, and ONSD/EVD ratios at the end of therapy were significantly lower compared with baseline measurements. At the end of therapy, ONSD measurements and ratios were similar among DKA severity groups. CONCLUSION The ONSD measurements and ratios decreased from the beginning of DKA treatment, which could be considered as an indicator of an increase in intracranial pressure at the time of admission. Ocular US may serve as a promising tool to perform further risk stratification of children with DKA and to identify DKA-related CE.
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Affiliation(s)
- Nihan Şık
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - İbrahim Mert Erbaş
- Division of Pediatric Endocrinology, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Korcan Demir
- Division of Pediatric Endocrinology, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Durgül Yılmaz
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Murat Duman
- Division of Pediatric Emergency Care, Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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16
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Marshall-Goebel K, Macias BR, Laurie SS, Lee SMC, Ebert DJ, Kemp DT, Miller A, Greenwald SH, Martin DS, Young M, Hargens AR, Levine BD, Stenger MB. Mechanical countermeasures to headward fluid shifts. J Appl Physiol (1985) 2021; 130:1766-1777. [PMID: 33856253 DOI: 10.1152/japplphysiol.00863.2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Head-to-foot gravitationally induced hydrostatic pressure gradients in the upright posture on Earth are absent in weightlessness. This results in a relative headward fluid shift in the vascular and cerebrospinal fluid compartments and may underlie multiple physiological consequences of spaceflight, including the spaceflight-associated neuro-ocular syndrome. Here, we tested three mechanical countermeasures [lower body negative pressure (LBNP), venoconstrictive thigh cuffs (VTC), and impedance threshold device (ITD) resistive inspiratory breathing] individually and in combination to reduce a posture-induced headward fluid shift as a ground-based spaceflight analog. Ten healthy subjects (5 male) underwent baseline measures (seated and supine postures) followed by countermeasure exposure in the supine posture. Noninvasive measurements included ultrasound [internal jugular veins (IJV) cross-sectional area, cardiac stroke volume, optic nerve sheath diameter, noninvasive IJV pressure], transient evoked otoacoustic emissions (OAE; intracranial pressure index), intraocular pressure, choroidal thickness from optical coherence tomography imaging, and brachial blood pressure. Compared with the supine posture, IJV area decreased 48% with application of LBNP [mean ratio: 0.52, 95% confidence interval (CI): 0.44-0.60, P < 0.001], 31% with VTC (mean ratio: 0.69, 95% CI: 0.55-0.87, P < 0.001), and 56% with ITD (mean ratio: 0.44, 95% CI: 0.12-1.70, P = 0.46), measured at end-inspiration. LBNP was the only individual countermeasure to decrease the OAE phase angle (Δ -12.9 degrees, 95% CI: -25 to -0.9, P = 0.027), and use of combined countermeasures did not result in greater effects. Thus, LBNP, and to a lesser extent VTC and ITD, represents promising headward fluid shift countermeasures but will require future testing in analog and spaceflight environments.NEW & NOTEWORTHY As a weightlessness-induced headward fluid shift is hypothesized to be a primary factor underlying several physiological consequences of spaceflight, countermeasures aimed at reversing the fluid shift will likely be crucial during exploration-class spaceflight missions. Here, we tested three mechanical countermeasures individually and in various combinations to reduce a posture-induced headward fluid shift as a ground-based spaceflight analog.
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Affiliation(s)
| | | | | | | | | | - David T Kemp
- University College London Ear Institute, London, United Kingdom
| | | | | | | | | | - Alan R Hargens
- Department of Orthopaedic Surgery, UC San Diego Medical Center, University of California, San Diego, California
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, UT Southwestern, Dallas, Texas
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17
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Biggs A, Lovett M, Moore-Clingenpeel M, O'Brien N. Optic nerve sheath diameter does not correlate with intracranial pressure in pediatric neurocritical care patients. Childs Nerv Syst 2021; 37:951-957. [PMID: 33009927 DOI: 10.1007/s00381-020-04910-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/28/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE Intracranial pressure (ICP) > 20 mmHg is associated with worse outcomes in children. The gold standard for monitoring ICP is invasive, has complications such as bleeding and infection, and may not be available in resource limited areas. Ultrasound of the optic nerve sheath diameter (ONSD) has been studied as a noninvasive way to evaluate for elevated ICP in adults. Its utility in pediatrics remains unclear. METHODS A prospective study was performed in a pediatric intensive care unit in children ≤ 18 years old. ONSD ultrasound was performed using a 13-6 MHz linear probe with the patient's invasively measured ICP simultaneously recorded. Linear mixed effects models were used to evaluate the association between ONSD and ICP. RESULTS One hundred thirty-six measurements were obtained from 16 patients. ONSD was not significantly associated with ICP (p = 0.51). A ROC curve assessing ONSD to determine elevated ICP > 20 mmHg had an area under the curve of 0.52 (95%CI = 0.32-0.72). There was no difference in measurements obtained between the left and right ONSD at the same time (p = 0.82). CONCLUSIONS In conclusion, this study demonstrated no association between ONSD measurement and invasively monitored ICP in critically ill children.
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Affiliation(s)
- Austin Biggs
- Division of Pediatric Critical Care, Medical University of South Carolina, Charleston, SC, USA.
| | - Marlina Lovett
- Division of Critical Care, Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Nicole O'Brien
- Division of Critical Care, Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University College of Medicine, Columbus, OH, USA
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18
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Efficacy of Noninvasive Technologies in Triaging Traumatic Brain Injury and Correlating With Intracranial Pressure: A Prospective Study. J Surg Res 2021; 262:27-37. [PMID: 33540153 DOI: 10.1016/j.jss.2020.12.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND There is interest in methods of measuring noninvasive intracranial pressure (ICP), including pupillometry, ultrasonographic transcranial Doppler (TCD), and optic nerve sheath diameter (ONSD), for diagnosing traumatic brain injury (TBI) in limited resource environments. Whether these technologies have diagnostic agreement is unknown. We hypothesized that ONSD, pupillometry, and TCD could both distinguish severe TBI and correlate with ICP. METHODS A prospective study of 135 patients was conducted at a level 1 trauma center. Four test groups were established: nontrauma patients with ICP monitoring, trauma patients without TBI, trauma patients with mild TBI, and trauma patients with severe TBI with ICP monitoring. All patients underwent daily measurements of ONSD, pupillometry, and TCD with both CX50 Sonosite and the Spencer ST3 Yi Pencil probe. RESULTS ONSD differed significantly in patients with severe TBI compared with patients with mild and no TBI, but did not correlate with ICP. Pupillometric constriction velocity, dilation velocity, and percent change in pupil diameter were significantly different in patients with severe TBI, but also did not correlate with ICP. TCD did not differ among TBI severities, but middle cerebral artery peak systolic velocity, middle cerebral artery flow velocity, and carotid flow velocity correlated with ICP. CONCLUSIONS This is a novel study of four noninvasive tests to screen for severity of TBI and measure ICP. Our analysis indicates that no single device can do both. However, ONSD and pupillometry may be used as a supplementary screening tool for severe TBI, whereas TCD could be used to estimate and follow ICP in patients with severe TBI.
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19
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Al-Hassani A, Strandvik G, Abayazeed S, Ahmed K, El-Menyar A, Mahmood I, Arumugam SK, Asim M, Nabir S, Ahmed N, Ahmed Z, Al-Thani H. Relationship of Optic Nerve Sheath Diameter and Intracranial Hypertension in Patients with Traumatic Brain Injury. J Emerg Trauma Shock 2020; 13:183-189. [PMID: 33304067 PMCID: PMC7717459 DOI: 10.4103/jets.jets_103_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/09/2019] [Accepted: 12/10/2019] [Indexed: 11/04/2022] Open
Abstract
Background to study the association between optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in patients with moderate-to-severe brain injury. Patients and Methods A retrospective cohort study of traumatic brain injury (TBI) patients was conducted between 2010 and 2014. Data were analyzed and compared according to the ICP monitoring cutoff values. Outcomes included intracranial hypertension (ICH) and mortality. Results A total of 167 patients with a mean age of 33 ± 14 years, of them 96 had ICP monitored. ICP values correlated with ONSD measurement (r = 0.21, P = 0.04). Patients who developed ICH were more likely to have higher mean ONSD (P = 0.01) and subarachnoid hemorrhage (SAH) (P = 0.004). Receiver operating curve for ONSD showed a cutoff value of 5.6 mm to detect ICH with sensitivity 72.2% and specificity 50%. Age and ICP were independent predictors of inhospital mortality in multivariate model. Another model with same covariates showed ONSD and SAH to be independent predictors of ICH. Simple linear regression showed a significant association of ONSD with increased ICP (β = 0.21, 95% confidence interval 0.25-5.08, P = 0.03). Conclusions ONSD is a simple noninvasive measurement on initial CT in patients with TBI that could be a surrogate for ICP monitoring. However, further studies are warranted.
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Affiliation(s)
| | | | | | - Khalid Ahmed
- Department of Surgery and, Hamad General Hospital, Doha, Qatar
| | - Ayman El-Menyar
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar.,Department of Surgery, Clinical Medicine, Weill Cornell Medical School, Doha, Qatar
| | - Ismail Mahmood
- Department of Surgery and, Hamad General Hospital, Doha, Qatar
| | | | - Mohammad Asim
- Department of Surgery, Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Syed Nabir
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Nadeem Ahmed
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Zahoor Ahmed
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Hassan Al-Thani
- Department of Surgery and, Hamad General Hospital, Doha, Qatar
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20
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Cardim D, Czosnyka M, Chandrapatham K, Badenes R, Bertuccio A, Noto AD, Donnelly J, Pelosi P, Ball L, Hutchinson PJ, Robba C. Effects of Age and Sex on Optic Nerve Sheath Diameter in Healthy Volunteers and Patients With Traumatic Brain Injury. Front Neurol 2020; 11:764. [PMID: 32849220 PMCID: PMC7426488 DOI: 10.3389/fneur.2020.00764] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/22/2020] [Indexed: 01/24/2023] Open
Abstract
The measurement of optic nerve sheath diameter (ONSD) has been reported as a non-invasive marker for intracranial pressure (ICP). Nevertheless, it is uncertain whether possible ONSD differences occur with age and sex in healthy and brain-injured populations. The aim of this study was to investigate the effects of sex and age on ONSD in healthy volunteers and patients with traumatic brain injury. We prospectively included 122 healthy adult volunteers (Galliera Hospital, Genova, Italy), and compared age/sex dependence of ONSD to 95 adult patients (Addenbrooke's Hospital, Cambridge, UK) with severe traumatic brain injury (TBI) requiring intubation and invasive ICP monitoring. The two groups were stratified for sex and age. Age was divided into 3 subgroups: (1) young adults: 18–44 years; (2) middle-aged adults: 45–64 years; (3) old adults: >65 years. In healthy volunteers, ONSD was significantly different between males and females [median (interquartile range): 4.2 (3.9–4.6) mm vs. 4.1 (3.6–4.2) mm (p = 0.01), respectively] and was correlated with age (R = 0.50, p < 0.0001). ONSD was significantly increased in group 3 compared to groups 2 and 1, indicating that ONSD values are higher in elderly subjects. In TBI patients, no differences in ONSD were found for sex and the correlation between ONSD and age was non-significant (R = 0.13, p = 0.20). ONSD increases with age and is significantly larger for males in healthy volunteers but not in TBI patients. Different ONSD cut-off values need not be age- or sex-adjusted for the assessment of increased ICP in TBI patients.
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Affiliation(s)
- Danilo Cardim
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, United States.,Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.,Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland
| | - Karthikka Chandrapatham
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Rafael Badenes
- University of Valencia Hospital Clinic, Anesthesiology and Surgical-Trauma Intensive Care, Valencia, Spain
| | - Alessandro Bertuccio
- Department of Neurosurgery, S. Cesare, Arrigo, Antonio, Biagio, Alessandria, Italy
| | - Anna Di Noto
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, University of Genoa, Genoa, Italy
| | - Joseph Donnelly
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.,Department of Anesthesiology, University of Auckland, Auckland, New Zealand
| | - Paolo Pelosi
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, University of Genoa, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Lorenzo Ball
- Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, University of Genoa, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Chiara Robba
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.,Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, University of Genoa, Genoa, Italy
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21
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Lee SH, Kim HS, Yun SJ. Optic nerve sheath diameter measurement for predicting raised intracranial pressure in adult patients with severe traumatic brain injury: A meta-analysis. J Crit Care 2020; 56:182-187. [PMID: 31945584 DOI: 10.1016/j.jcrc.2020.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 01/04/2020] [Accepted: 01/07/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate and compare the diagnostic feasibility of measuring the optic nerve sheath diameter (ONSD), via brain computed tomography (CT) and ocular ultrasonography (US) for prediction of raised intracranial pressure (ICP) in severe traumatic brain injury (TBI) patients. METHODS The PubMed and EMBASE databases were searched for studies assessing the diagnostic accuracy of brain CT or ocular US for predicting raised ICP. Bivariate and hierarchical summary receiver operating characteristic modeling were performed to evaluate and compare the diagnostic feasibility of measuring the ONSD in adult patients with severe TBI according to modality (ocular US vs. brain CT). RESULTS Five studies (four with ocular US and one with brain CT) were included. The ONSD had a pooled sensitivity of 0.91, pooled specificity of 0.77, and area under the HSROC curve of 0.92 for predicting raised ICP. More importantly, studies using ocular US found an almost equal sensitivity (0.91 vs. 0.90; p = .35) and higher specificity (0.82 vs. 0.58; p = .01) than those using brain CT. CONCLUSIONS Measurement of the ONSD may be a useful method for predicting raised ICP in adult patients with severe TBI.
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Affiliation(s)
- Sun Hwa Lee
- Department of Emergency Medicine, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Republic of Korea
| | - Hyun Soo Kim
- Department of Medicine, Graduate School, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Seong Jong Yun
- Department of Radiology, G SAM Hospital, 591 Gunpo-ro, Gunpo 15839, Republic of Korea.
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22
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Optic nerve sheath diameter measurement for predicting raised intracranial pressure in pediatric patients: A systematic review and meta-analysis. HONG KONG J EMERG ME 2019. [DOI: 10.1177/1024907919892775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background and objectives:No previous studies have investigated the relationship between the optic nerve sheath diameter and raised intracranial pressure in pediatric patients or have evaluated the usefulness of optic nerve sheath diameter in ocular ultrasound and brain computed tomography/magnetic resonance imaging. This study aimed to meta-analyze the diagnostic performance of optic nerve sheath diameter for the diagnosis of raised intracranial pressure in pediatric patients.Methods:A database search of PubMed and EMBASE was performed to identify relevant studies. Bivariate modeling and hierarchical summary receiver operating characteristics modeling were performed to evaluate diagnostic performance. A pooled diagnostic odds ratio with a 95% confidence interval, not including 1, was considered informative. Subgroup analysis was performed according to the modality (ocular ultrasound vs brain computed tomography/magnetic resonance imaging). We performed meta-regression analyses for heterogeneity exploration.Results:Eleven studies involving 546 patients were included. According to pooled diagnostic odds ratios, optic nerve sheath diameter was informative for the evaluation of raised intracranial pressure (diagnostic odds ratio, 47; 95% confidence interval, 11–206). Optic nerve sheath diameter showed a pooled sensitivity of 0.88 (95% confidence interval, 0.79–0.94), a pooled specificity of 0.86 (95% confidence interval, 0.70–0.95), and an area under the hierarchical summary receiver operating characteristics curve of 0.93 (95% confidence interval, 0.91–0.95) for the diagnosis of raised intracranial pressure. According to the subgroup analysis, ocular ultrasound (sensitivity, 0.91 (95% confidence interval, 0.81–0.96); specificity, 0.86 (95% confidence interval, 0.65–0.96)) showed higher sensitivity and comparable specificity than optic nerve sheath diameter measured on brain computed tomography/magnetic resonance imaging (sensitivity, 0.75 (95% confidence interval, 0.51–0.99); specificity, 0.91 (95% confidence interval, 0.74–1.00)). On meta-regression analysis, the study design, number of patients, and reference standard were the sources of heterogeneity.Conclusion:Optic nerve sheath diameter may be a useful method for predicting raised intracranial pressure in pediatric patients. We recommend that the measurement of optic nerve sheath diameter should be performed using ocular ultrasound for a more accurate diagnosis of raised intracranial pressure in pediatric patients.
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23
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Hunt A, Tasker RC, Deep A. Neurocritical care monitoring of encephalopathic children with acute liver failure: A systematic review. Pediatr Transplant 2019; 23:e13556. [PMID: 31407855 DOI: 10.1111/petr.13556] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/14/2019] [Accepted: 07/04/2019] [Indexed: 12/15/2022]
Abstract
Research on non-invasive neuromonitoring specific to PALF is limited. This systematic review identifies and synthesis the existing literature on non-invasive approaches to monitoring for neurological sequelae in patients with PALF. A series of literature searches were performed to identify all publications pertaining to five different non-invasive neuromonitoring modalities, in line with PRISMA guidelines. Each modality was selected on the basis of its potential for direct or indirect measurement of cerebral perfusion; studies on electroencephalographic monitoring were therefore not sought. Data were recorded on study design, patient population, comparator groups, and outcomes. A preponderance of observational studies was observed, most with a small sample size. Few incorporated direct comparisons of different modalities; in particular, comparison to invasive intracranial pressure monitoring was largely lacking. The integration of current evidence is considered in the context of the clinically significant distinctions between pediatric and adult ALF, as well as the implications for planning of future investigations to best support the evidence-based clinical care of these patients.
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Affiliation(s)
- Adam Hunt
- University College Hospital, London, UK
| | - Robert C Tasker
- Harvard Medical School, Chair in Neurocritical Care, Boston Children's Hospital, Boston, MA
| | - Akash Deep
- Paediatric Intensive Care, King's College Hospital, London, UK
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24
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Bedside Ultrasonography of the Optic Nerve Sheath in Brain Death. Transplant Proc 2019; 51:2180-2182. [PMID: 31377068 DOI: 10.1016/j.transproceed.2019.01.151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 01/31/2019] [Indexed: 11/23/2022]
Abstract
Increased intracranial pressure has successfully been detected by using bedside optic nerve sheath diameter (ONSD) ultrasonography. ONSD ultrasonography has become one of the current methods used to detect potential brain death in recent years. In this study, we carried out ONSD ultrasonography for patients who were diagnosed with brain death and in comatose state. Mean ONSD values obtained from the patients with brain death were compared with ONSD values of patients in a comatose state. There was no significant difference between the mean ONSD values of the right and left eye and no significant difference in transverse and sagittal plane measurements in all groups. Mean ONSD values of Group BD were significantly higher than both Group CT (P < .05) and Group CM values (P < .05). Some of the patients with a history of intracranial hemorrhage, subdural hematoma, or traumatic brain injuries who remain in a comatose state in intensive care units may ultimately result in brain death. Therefore, it may be kept in mind that intermittent ONSD measurements of patients in deep comas might have an important role for diagnosing brain death early for purposes of cadaveric organ donation. In conclusion, transorbital ONSD measurement using bedside ultrasonography, an inexpensive, comfortable, and noninvasive test for patients in deep comas, may be helpful in determining potential brain death.
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Lee SH, Jong Yun S. Diagnostic performance of optic nerve sheath diameter for predicting neurologic outcome in post-cardiac arrest patients: A systematic review and meta-analysis. Resuscitation 2019; 138:59-67. [DOI: 10.1016/j.resuscitation.2019.03.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/20/2019] [Accepted: 03/02/2019] [Indexed: 01/14/2023]
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Robba C, Donnelly J, Cardim D, Tajsic T, Cabeleira M, Citerio G, Pelosi P, Smielewski P, Hutchinson P, Menon DK, Czosnyka M. Optic nerve sheath diameter ultrasonography at admission as a predictor of intracranial hypertension in traumatic brain injured patients: a prospective observational study. J Neurosurg 2019; 132:1279-1285. [PMID: 30849751 DOI: 10.3171/2018.11.jns182077] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 11/19/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Intracranial hypertension and impaired cerebral autoregulation are common causes of secondary injuries in patients with traumatic brain injury (TBI). The primary outcome of this study was to assess whether a noninvasive method to estimate intracranial pressure (ICP) based on the ultrasonography of the optic nerve sheath diameter (ONSD) measured at the time of neurocritical care unit (NCCU) admission is correlated with the mean ICP during NCCU stay. Secondary outcomes were to assess whether ONSD is correlated with the dose of ICP > 20 mm Hg and impaired autoregulation during NCCU stay and with instantaneous ICP and whether ONSD is associated with NCCU mortality. METHODS This prospective observational monocentric study included adults with severe TBI. ONSD was measured at NCCU admission, immediately after invasive ICP insertion. ONSD-predicted noninvasive ICP (nICPONSD) was calculated according the formula: nICPONSD = 5 × ONSD - 14 (nICPONSD in mm Hg, ONSD in mm). Autoregulation was measured using the pressure reactivity index (PRx). RESULTS In total, 100 patients were included in this study. ONSD was significantly correlated with mean ICP (r = 0.46, p < 0.0001), with mean PRx (r = 0.21, p = 0.04), and with the dose of ICP > 20 mm Hg during NCCU stay (r = 0.49, p < 0.0001). Admission nICPONSD was shown to be significantly correlated with instantaneous ICP (r = 0.85, p < 0.001). ONSD at admission was significantly correlated with NCCU mortality (p = 0.02). CONCLUSIONS ONSD measured at NCCU admission can give important information about patients at risk of developing intracranial hypertension and impaired autoregulation. ONSD examination could be useful to screen patients at admission to determine who would benefit from further invasive ICP monitoring.
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Affiliation(s)
- Chiara Robba
- 1Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, University of Genoa, Genoa, Italy.,2Neurointensive Care, Addenbrooke's Hospital, and
| | - Joseph Donnelly
- 3Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.,4Department of Anaesthesiology, University of Auckland, Auckland, New Zealand
| | - Danilo Cardim
- 3Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.,5Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tamara Tajsic
- 6Division of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Manuel Cabeleira
- 3Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Giuseppe Citerio
- 7School of Medicine and Surgery, University Milan Bicocca Neurointensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, ASST-Monza, Italy
| | - Paolo Pelosi
- 1Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, University of Genoa, Genoa, Italy.,8Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy; and
| | - Peter Smielewski
- 3Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Peter Hutchinson
- 6Division of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | | | - Marek Czosnyka
- 3Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.,9Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland
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Lee S, Kim YO, Baek JS, Ryu JA. The prognostic value of optic nerve sheath diameter in patients with subarachnoid hemorrhage. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2019; 23:65. [PMID: 30808383 PMCID: PMC6390328 DOI: 10.1186/s13054-019-2360-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/14/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND We evaluated the role of optic nerve sheath diameter (ONSD) using brain computed tomography (CT) in predicting neurological outcomes of patients with subarachnoid hemorrhage (SAH). METHODS This was a retrospective, multicenter, observational study of adult patients with SAH admitted between January 2012 and June 2017. Initial brain CT was performed within 12 h from onset of SAH, and follow-up brain CT was performed within 24 h from treatment of a ruptured aneurysm. Primary outcome was neurological status at 6-month follow-up assessed with the Glasgow Outcome Scale (GOS, 1 to 5). RESULTS Among 223 SAH patients, 202 (90.6%) survived until discharge. Of these survivors, 186 (83.4%) manifested favorable neurological outcomes (GOS of 3, 4, or 5). In this study, the ONSDs in the group of patients with poor neurological outcome were significantly greater than those in the favorable neurological outcome group (all p < 0.01). Intracranial pressure (ICP) was monitored in 21 (9.4%) patients during the follow-up CT. A linear correlation existed between the average ONSD and ICP in simple correlation analysis (r = 0.525, p = 0.036). Analysis of the receiver operating characteristic curve for prediction of poor neurological outcome showed that ONSD had considerable predictive value (C-statistics, 0.735 to 0.812). In addition, the performance of a composite of Hunt and Hess grade and ONSD was increasingly associated with poor neurological outcomes than the use of each marker alone. CONCLUSIONS ONSD measured with CT may be used in combination with clinical grading scales to improve prognostic accuracy in SAH patients.
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Affiliation(s)
- Sangkil Lee
- Department of Neurology, ChungBuk National University Hospital, Cheongju, Republic of Korea
| | - Yong Oh Kim
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Ji Sun Baek
- Department of Ophthalmology, Konyang University, Kim's Eye Hospital, Myung-Gok Eye Research Institute, Seoul, Republic of Korea
| | - Jeong-Am Ryu
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea. .,Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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Association of optic nerve sheath diameter measurement with hyponatremia in emergency department. Am J Emerg Med 2019; 37:1876-1879. [PMID: 30622006 DOI: 10.1016/j.ajem.2018.12.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/26/2018] [Accepted: 12/27/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Investigation of association of ONSD with hyponatremia in symptomatic patients. METHODS 89 patients who were diagnosed to have hyponatremia (Na + <135 mmol/L) were prospectively analyzed and compared with 72 patients who have normal serum sodium levels presented to ED at the same time interval. Subjects' demographic properties including age and sex were recorded, as were admission symptoms, serum Na + level, and pre-treatment and post-treatment optic nerve sheath diameter (ONSD). RESULTS The mean age of the study population was 62.3 ± 17.6 years, and the control group 55.1 ± 20.0 years (p < 0.05). There was a significant difference between the patient group's pre-treatment and post-treatment OSNDs compared to the controls (p < 0.05). There was a significant negative correlation between the admission sodium level and ONSD in the patient group (p < 0.05). In the pre-treatment period, patients with symptoms had a significantly greater mean ONSD than those without symptoms (0.546 ± 0.068 mm vs 0.448 ± 0.081 mm; p < 0.05). The area under the curve was 0.870; the cut-off level calculated for hyponatremia was 0.49 mm, which had a sensitivity of 81% and a specificity of 81.9%. CONCLUSION Ultrasonic imaging of ONSD measurement in the emergency department appears to reflect changes consistent with ICP changes in hyponatremia and change in serum sodium.
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Cardim D, Griesdale DE, Ainslie PN, Robba C, Calviello L, Czosnyka M, Smielewski P, Sekhon MS. A comparison of non-invasive versus invasive measures of intracranial pressure in hypoxic ischaemic brain injury after cardiac arrest. Resuscitation 2019; 137:221-228. [PMID: 30629992 DOI: 10.1016/j.resuscitation.2019.01.002] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/23/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
AIM Increased intracranial pressure (ICP) in hypoxic ischaemic brain injury (HIBI) can cause secondary ischaemic brain injury and culminate in brain death. Invasive ICP monitoring is limited by associated risks in HIBI patients. We sought to evaluate the agreement between invasive ICP measurements and non-invasive estimators of ICP (nICP) in HIBI patients. METHODS Eligible consecutive adult (age>18) cardiac arrest patients with HIBI were included as part of a single centre prospective interventional study. Invasive ICP monitoring and nICP measurements were undertaken using: a) transcranial Doppler ultrasonography (TCD), b) optic nerve sheet diameter ultrasound (ONSD) and c) jugular venous bulb pressure (JVP). Multiple measurements applied in linear mixed-effects models were considered to obtain the correlation coefficient between ICP and nICP as well as their predictive abilities to detect intracranial hypertension (ICP≥20mm Hg). RESULTS Eleven patients were included (median age of 47 [range 20-71], 8 males and 3 females). There was a linear relationship between ICP and nICP with ONSD (R=0.53 [p<0.0001]), JVP (R=0.38 [p<0.001]) and TCD (R=0.30 [p<0.01]). The ability to predict intracranial hypertension was highest for ONSD and TCD (area under the receiver operating curve (AUC)=0.96 [95% CI: 0.90-1.00] and AUC=0.91 [95% CI: 0.83-1.00], respectively). JVP presented the weakest prediction ability (AUC=0.75 [95% CI: 0.56-0.94]). CONCLUSIONS ONSD and TCD methods demonstrated agreement with invasively-monitored ICP, suggesting their potential roles in the detection of intracranial hypertension in HIBI after cardiac arrest.
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Affiliation(s)
- Danilo Cardim
- Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, The University of British Columbia, Vancouver, BC, Canada,.
| | - Donald E Griesdale
- Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, The University of British Columbia, Vancouver, BC, Canada,; Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, The University of British Columbia, Vancouver, BC, Canada,; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, The University of British Columbia, Vancouver, BC, Canada
| | - Philip N Ainslie
- Department of Health and Exercise Sciences, The University of British Columbia - Okanagan, Kelowna, BC, Canada
| | - Chiara Robba
- Anaesthesia and Intensive Care, IRCCS San Martino, Genova, Italy
| | - Leanne Calviello
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, United Kingdom; Institute of Electronic Systems, Warsaw University of Technology, Poland
| | - Peter Smielewski
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - Mypinder S Sekhon
- Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, The University of British Columbia, Vancouver, BC, Canada
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Kumar R, Bala R, Banerjee A, Taxak S. Optic nerve sheath diameter measured using ocular sonography is raised in patients with eclampsia. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2019. [DOI: 10.4103/joacc.joacc_1_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Gao Y, Li Q, Wu C, Liu S, Zhang M. Diagnostic and prognostic value of the optic nerve sheath diameter with respect to the intracranial pressure and neurological outcome of patients following hemicraniectomy. BMC Neurol 2018; 18:199. [PMID: 30518315 PMCID: PMC6280512 DOI: 10.1186/s12883-018-1202-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 11/20/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In cases showing cerebrospinal fluid (CSF) redistribution as a compensatory mechanism in acute intracranial hypertension, the optic nerve sheath diameter (ONSD) can be used to estimate intracranial pressure (ICP). However, it remains unclear whether the ONSD can be applied in patients with skull defects after a craniectomy, because the primary injury or surgical craniectomy may alter the dynamics of the CSF circulation or structure of the optical nerve sheath. This study explored the value of the ONSD in patients after a hemicraniectomy. METHODS This prospective observational study enrolled patients after a hemicraniectomy. All patients underwent invasive ICP monitoring and ocular ultrasound within 6 h postoperatively. We followed the patients for 6 months and evaluated them using the Glasgow Outcome Score (GOS), classifying the outcome as favorable (GOS 4-5) or unfavorable (GOS 1-3). We evaluated the ONSD in both according to the ICP and neurological outcome. RESULTS Of the 33 enrolled patients, 20 (60.6%) had an unfavorable outcome at 6 months. Disagreement was seen in the ONSD measurements between the eyes [craniectomy side (ONSDips) and opposite side (ONSDcon)]. The intraclass correlation coefficient between ONSDips and ONSDcon was 0.745 (p < 0.001). ONSD had no significant correlation with ICP in Spearman correlation analysis (ONSDips r = 0.205, p = 0.252; ONSDcon r = 0.164, p = 0.362). Receiver operator characteristic (ROC) curve analysis revealed that the GCS, Helsinki computed tomography (CT) score, pupil reaction, and ONSDcon measured after the craniectomy were significantly associated with a poor outcome. ONSDcon > 5.5 mm predicted a poor outcome, with an area under the ROC curve of 0.717 (95% confidence interval, 0.534-0.860, p = 0.02), 70% sensitivity, and 69.2% specificity. CONCLUSIONS After hemicraniectomy, the ONSD measured on ultrasound was unreliable for evaluating ICP, but showed potential prognostic value for a poor neurological outcome.
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Affiliation(s)
- Yuzhi Gao
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou City, 310009, Zhejiang Province, China
| | - Qiang Li
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou City, 310009, Zhejiang Province, China
| | - Chunshuang Wu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou City, 310009, Zhejiang Province, China
| | - Shaoyun Liu
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou City, 310009, Zhejiang Province, China
| | - Mao Zhang
- Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88, Jiefang Road, Hangzhou City, 310009, Zhejiang Province, China.
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Sönmez BM, Temel E, İşcanlı MD, Yılmaz F, Gülöksüz U, Parlak S, Uçkun ÖM. Is initial optic nerve sheath diameter prognostic of specific head injury in emergency departments? J Natl Med Assoc 2018; 111:210-217. [PMID: 30415927 DOI: 10.1016/j.jnma.2018.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/11/2018] [Accepted: 10/05/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Emergency departments (EDs) are typically the first medical contact for patients with traumatic brain injury (TBI) and early diagnosis and treatment of intracranial pressure (ICP) in patients with neurotrauma primarily falls under the liability of emergency doctors. Monitoring ICP with optic nerve sheath diameter (ONSD) via tools has gained popularity among emergency service doctors. In this study, we aimed to evaluate the predictive value of ONSD for specific head injury on initial cranial tomography. METHODS CT scans of 176 patients with a known intracranial pathology were retrospectively analyzed and compared with normal control CTs of 182 patients presented to ED at the same time interval. The attending radiologist analyzed all initial brain CT scans and randomly sampled control CTs were similarly assessed by the second senior radiologist whom were blind to the patients' medical histories and circumstances of TBI at the time of measurement. ONSD was measured at a distance of 3 mm behind the eyeball, immediately below the sclera. RESULTS Right ONSD value was significantly higher in patients with herniation and SAH (p = 0,024 and 0,028, respectively). Left ONSD values was at the level of statistical significance and mean ONSD values was significantly higher in patients with SAH (p = 0.05 and 0.026, respectively). Right-left-mean ONSD values were statistically higher in study group with bilateral lesions on brain CT (p < 0,001). ONSD measurements and patient age were higher in patients who died (p < 0,001). CONCLUSIONS ONSD measurement on initial brain CT is lesion dependent and indicates mortality.
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Affiliation(s)
- Bedriye Müge Sönmez
- Ankara Numune Education and Research Hospital; Department of Emergency Medicine, Ankara, Turkey.
| | - Emirhan Temel
- Ankara Numune Education and Research Hospital; Department of Radiology, Ankara, Turkey
| | - Murat Doğan İşcanlı
- Ankara Numune Education and Research Hospital; Department of Emergency Medicine, Ankara, Turkey
| | - Fevzi Yılmaz
- Ankara Numune Education and Research Hospital; Department of Emergency Medicine, Ankara, Turkey
| | - Uğur Gülöksüz
- Ankara Numune Education and Research Hospital; Department of Emergency Medicine, Ankara, Turkey
| | - Selçuk Parlak
- Ankara Numune Education and Research Hospital; Department of Radiology, Ankara, Turkey
| | - Özhan Merzuk Uçkun
- Ankara Numune Education and Research Hospital; Department of Neurosurgery, Ankara, Turkey
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Houzé-Cerfon CH, Bounes V, Guemon J, Le Gourrierec T, Geeraerts T. Quality And Feasibility of Sonographic Measurement of the Optic Nerve Sheath Diameter to Estimate the Risk of Raised Intracranial Pressure After Traumatic Brain Injury in Prehospital Setting. PREHOSP EMERG CARE 2018; 23:277-283. [PMID: 30118380 DOI: 10.1080/10903127.2018.1501444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE In patients with traumatic brain injury (TBI), early detection and subsequent prompt treatment of elevated intracranial pressure (ICP) is a challenge in the prehospital setting, because physical examination is limited in comatose patients and invasive device placement is not possible. The aim of this study was to evaluate the quality and feasibility of optic nerve sheath diameter (ONSD) measurements obtained during the prehospital management of patients with TBI. METHODS This study was a prospective, observational study of 23 patients with moderate and severe TBI during prehospital medical care. The primary endpoint was the quality of ONSD measurements expressed as the percentage of ONSD validated by the experts. Secondary endpoints included the feasibility of ONSD measurements as the percentage of ONSD performed and assessment by operators of ease and duration to perform. RESULTS Ultrasound ONSD was performed in 19 (82%) patients and 80% of ONSD measurements were validated by the experts. The ONSD measurements were possible in 15 (79%) cases. The physicians have assessed the ease of use at 8 (interquartile range [IQR] = 2.5-8) on 10 for and the median time to obtain ONSD measurement was 4 min (IQR = 3-5). ONSD measurement was performed in 12 (63%) cases during the transport and in 7 (37%) cases on scene, with 58% (n = 7) and 71% (n = 5) validated ONSD, respectively. The success rate in the helicopter was 43% compared to 80% in the ambulance. CONCLUSION This study shows that it is feasible to obtain high-quality ONSD measurements in the management of patients with TBI in a prehospital setting. A randomized study evaluating the usefulness of ONSD to guide management of TBI in the prehospital phase may be of great interest.
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Guvenc G, Kizmazoglu C, Aydin HE. Effect of Mannitol Infusion on Optic Nerve Injury After Acute Traumatic Subarachnoid Hemorrhage and Brain Injury. J Craniofac Surg 2018; 29:1772-1775. [PMID: 30106807 DOI: 10.1097/scs.0000000000004827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The primary aim of this paper is to investigate the neuroprotective and antiinflammatory effects of mannitol on optic nerve injury after acute traumatic subarachnoid hemorrhage and brain injury in rat models. Traumatic brain injury (TBI) and traumatic subarachnoid hemorrhage (tSAH) were produced by a custom-made weight-drop impact acceleration device. Thirty male Wistar rats were divided into 3 groups. Group I (n = 10) was the sham group, group II (n = 10) received TBI, and group III (n = 10) received TBI + mannitol (1 mg/kg intravenously). Optic nerve tissue glutathione peroxidase (GPx) and interleukin 1 beta (IL-1β) levels were measured 4 hours after the trauma. The authors used Kruskal-Wallis variance analysis and Mann-Whitney U tests for statistical analysis. Optic nerve tissue GPx levels were significantly higher in group III than in groups I and II (P < 0.05). Optic nerve tissue IL-1β levels were significantly lower in group III than in group II (P < 0.05) and higher than in group I (P < 0.05).Mannitol increased the antioxidant GPx levels and decreased the IL-1β levels, which can protect the optic nerve from secondary injury after severe acute trauma. Mannitol plays an important role in the treatment of acute severe indirect optic nerve injury after TBI and tSAH.
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Affiliation(s)
- Gonul Guvenc
- Department of Neurosurgery, Ataturk Training and Research Hospital, Katip Celebi University
| | - Ceren Kizmazoglu
- Department of Neurosurgery, School of Medicine Hospital, Dokuz Eylul University, Izmir
| | - Hasan Emre Aydin
- Department of Neurosurgery, Evliya Celebi Training and Research Hospital, Dumlupinar University, Kutahya, Turkey
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Shin SS, Huisman TAGM, Hwang M. Ultrasound Imaging for Traumatic Brain Injury. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:1857-1867. [PMID: 29388231 DOI: 10.1002/jum.14547] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 10/17/2017] [Accepted: 10/30/2017] [Indexed: 06/07/2023]
Abstract
Traumatic brain injury (TBI) is challenging to assess even with recent advancements in computed tomography and magnetic resonance imaging. Ultrasound (US) imaging has previously been less utilized in TBI compared to conventional imaging because of limited resolution in the intracranial space. However, there have been substantial improvements in contrast-enhanced US and development of novel techniques such as intravascular US. Also, continued research provides further insight into cerebrovascular parameters from transcranial Doppler imaging. These advancements in US imaging provides the community of TBI imaging researchers and clinicians new opportunities in clinically monitoring and understanding the pathologic mechanisms of TBI.
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Affiliation(s)
- Samuel S Shin
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Thierry A G M Huisman
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Misun Hwang
- Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Lee DH, Lee SH, Oh JH, Cho IS, Lee YH, Han C, Choi WJ, Sohn YD. Optic nerve sheath diameter measured using early unenhanced brain computed tomography shows no correlation with neurological outcomes in patients undergoing targeted temperature management after cardiac arrest. Resuscitation 2018; 128:144-150. [PMID: 29763714 DOI: 10.1016/j.resuscitation.2018.04.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/26/2018] [Accepted: 04/29/2018] [Indexed: 01/27/2023]
Abstract
AIM Previous studies indicated that the optic nerve sheath diameter (ONSD) measured using brain computed tomography (CT) is a prognostic factor for poor neurological outcome after cardiac arrest. However, these studies were retrospective or included a small sample size. We performed a prospective multi-centre observational study to investigate the correlation between the ONSD on early brain CT and neurological outcomes in patients undergoing targeted temperature management (TTM). METHODS This study used data from the Korean Hypothermia Network prospective registry between November 2015 and October 2016. Out-of-cardiac arrest patients who underwent brain CT within 2 h after return of spontaneous circulation (ROSC) were included. The primary endpoint was neurological outcomes at 6 months (cerebral performance category; CPC); the secondary outcome was hospital mortality. The ONSD was measured using unenhanced brain CT images. RESULTS In total, 374 patients were included from 18 hospitals, and 329 underwent CT within 2 h after ROSC. Six months after cardiac arrest, good (CPC 1-2) and poor (CPC 3-5) neurological outcomes were observed in 99 (30.09%) and 230 (69.91%) patients, respectively. There was no significant difference in the ONSD between groups (good outcome group: 5.61 ± 0.59 mm, poor outcome group: 5.69 ± 0.79 mm; p = 0.275), nor between discharged patients who survived and those with hospital mortality (5.63 ± 0.64 mm and 5.70 ± 0.67 mm, respectively, p = 0.399). CONCLUSION The ONSD on initial brain CT after ROSC was not correlated with neurological outcome at 6 months in patients who underwent TTM.
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Affiliation(s)
- Dong Hoon Lee
- Department of Emergency Medicine, Chung-Ang University Hospital, College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea.
| | - Sun Hwa Lee
- Department of Emergency Medicine, Sanggye paik Hospital, Inje University, Dongil-ro 1342, Nowon-gu, Seoul, Republic of Korea.
| | - Je Hyeok Oh
- Department of Emergency Medicine, Chung-Ang University Hospital, College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea.
| | - In Soo Cho
- Department of Emergency Medicine, Hanil General Hospital, 308, Uicheon-ro, Dobong-gu, Seoul, Republic of Korea.
| | - Young Hwan Lee
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, 170 jomaru-ro, Wonmi-gu, Bucheon, Gyenggi-do, Republic of Korea.
| | - Chul Han
- Emergency Medicine, Ewha Womans University Medical Center, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea.
| | - Wook Jin Choi
- Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan, Republic of Korea.
| | - You Dong Sohn
- Department of Emergency Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, Republic of Korea; Department of Emergency Medicine, Seoul National University, College of Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
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Sen N. An insight into the vision impairment following traumatic brain injury. Neurochem Int 2017; 111:103-107. [PMID: 28163060 PMCID: PMC5540824 DOI: 10.1016/j.neuint.2017.01.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/20/2017] [Accepted: 01/30/2017] [Indexed: 01/08/2023]
Abstract
Traumatic brain injury (TBI) is one of the major cause of morbidity and mortality and it affects more than 1.7 million Americans each year. Depending on its location and severity, TBI leads to structural and functional damage in several parts of the brain such as cranial nerves, optic nerve tract or other circuitry involved in vision, and occipital lobe. As a result, the function associated with vision processing and perception are significantly affected and cause blurred vision, double vision, decreased peripheral vision and blindness. In this mini-review, we will focus the recent progress made to understand the pathology and underlying cellular/molecular mechanisms involved in the impairment of the integrity of visual systems following TBI.
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Affiliation(s)
- Nilkantha Sen
- Department of Neuroscience and Regenerative Medicine, Augusta University, 1120 15th Street, CA 2018, Augusta, GA 30907, USA.
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Marshall-Goebel K, Terlević R, Gerlach DA, Kuehn S, Mulder E, Rittweger J. Lower body negative pressure reduces optic nerve sheath diameter during head-down tilt. J Appl Physiol (1985) 2017; 123:1139-1144. [PMID: 28818998 DOI: 10.1152/japplphysiol.00256.2017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/14/2017] [Accepted: 08/14/2017] [Indexed: 01/06/2023] Open
Abstract
The microgravity ocular syndrome (MOS) results in significant structural and functional ophthalmic changes during 6-mo spaceflight missions consistent with an increase in cerebrospinal fluid (CSF) pressure compared with the preflight upright position. A ground-based study was performed to assess two of the major hypothesized contributors to MOS, headward fluid shifting and increased ambient CO2, on intracranial and periorbital CSF. In addition, lower body negative pressure (LBNP) was assessed as a countermeasure to headward fluid shifting. Nine healthy male subjects participated in a crossover design study with five head-down tilt (HDT) conditions: -6, -12, and -18° HDT, -12° HDT with -20 mmHg LBNP, and -12° HDT with a 1% CO2 environment, each for 5 h total. A three-dimensional volumetric scan of the cranium and transverse slices of the orbita were collected with MRI, and intracranial CSF volume and optic nerve sheath diameter (ONSD) were measured after 4.5 h HDT. ONSD increased during -6° (P < 0.001), -12° (P < 0.001), and -18° HDT (P < 0.001) and intracranial CSF increased during -12° HDT (P = 0.01) compared with supine baseline. Notably, LBNP was able to reduce the increases in ONSD and intracranial CSF during HDT. The addition of 1% CO2 during HDT, however, had no further effect on ONSD, but rather ONSD increased from baseline in a similar magnitude to -12° HDT with ambient air (P = 0.001). These findings demonstrate the ability of LBNP, a technique that targets fluid distribution in the lower limbs, to directly influence CSF and may be a promising countermeasure to help reduce increases in CSF.NEW & NOTEWORTHY This is the first study to demonstrate the ability of lower body negative pressure to directly influence cerebrospinal fluid surrounding the optic nerve, indicating potential use as a countermeasure for increased cerebrospinal fluid on Earth or in space.
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Affiliation(s)
- Karina Marshall-Goebel
- Neural Systems Group, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts; .,Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Robert Terlević
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany.,International Space University, Illkirch-Graffenstaden, France; and
| | - Darius A Gerlach
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Simone Kuehn
- University Clinic Hamburg-Eppendorf, Clinic for Psychiatry and Psychotherapy, Hamburg, Germany
| | - Edwin Mulder
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
| | - Jörn Rittweger
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany
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Albert AF, Kirkman MA. Clinical and Radiological Predictors of Malignant Middle Cerebral Artery Infarction Development and Outcomes. J Stroke Cerebrovasc Dis 2017; 26:2671-2679. [PMID: 28736129 DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/19/2017] [Accepted: 06/25/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Optic nerve sheath diameter (ONSD) can predict intracranial hypertension and outcomes in severe traumatic brain injury. Its utility in middle cerebral artery (MCA) stroke is unknown. AIMS We reviewed serial radiological measurements, including ONSD, in patients with MCA stroke undergoing decompressive craniectomy (DC) for malignant MCA syndrome and compared demographic, clinical, and radiological data with an age- and gender-matched group of nonmalignant MCA stroke patients. METHODS Patients admitted to a large tertiary hospital in London, UK, between April 2012 and October 2016 with MCA infarction were identified through 2 data sources. We quantified ONSD, eyeball transverse diameter (ETD), ONSD/ETD ratio, midline shift (MLS), and infarct volume on computed tomography (CT). RESULTS We identified 19 patients (mean age = 49.8 years [standard deviation = 12.5]) with malignant MCA stroke and 19 patients (47.8 years [16.0]) with nonmalignant MCA stroke. Mean ONSD, ONSD/ETD ratio, MLS, and infarct volume on initial CT all significantly increased after developing malignant MCA syndrome and decreased (except infarct volume, which increased) following DC (all Ps <.05). ONSD and ONSD/ETD ratios in the malignant group did not correlate with functional outcomes but were significantly higher on initial CT compared with the nonmalignant group (mean ONSD: 5.66 mm [.6] versus 4.97 mm [.5], P = .001; mean ONSD/ETD ratio: .25 [.03] versus .22 [.02], P = .002). CONCLUSIONS ONSD, ONSD/ETD ratio, MLS, and infarct volume change dynamically in patients with malignant MCA infarction who undergo DC. An ONSD of more than 5.25 mm and an ONSD/ETD ratio of more than .232 on initial CT may identify MCA stroke patients at high risk of developing malignant MCA syndrome.
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Affiliation(s)
| | - Matthew A Kirkman
- Department of Neurosurgery, The Royal London Hospital, Barts Heath NHS Trust, London, UK; The National Hospital for Neurology and Neurosurgery, University College London Hospitals, Queen Square, London, UK.
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Salahuddin N, Mohamed A, Alharbi N, Ansari H, Zaza KJ, Marashly Q, Hussain I, Solaiman O, Wetterberg TV, Maghrabi K. The incidence of increased ICP in ICU patients with non-traumatic coma as diagnosed by ONSD and CT: a prospective cohort study. BMC Anesthesiol 2016; 16:106. [PMID: 27776491 PMCID: PMC5078918 DOI: 10.1186/s12871-016-0267-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/09/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Unexplained coma after critical illness can be multifactorial. We evaluated the diagnostic ability of bedside Optic Nerve Sheath Diameter [ONSD] as a screening test for non-traumatic radiographic cerebral edema. METHODS In a prospective study, mixed medical-surgical intensive care units [ICU] patients with non-traumatic coma [GCS < 9] underwent bedside ultrasonographic ONSD measurements. Non-traumatic radiographic cerebral edema [NTRCE] was defined as > 5 mm midline shift, cisternal, sulcal effacement, or hydrocephalus on CT. RESULTS NTRCE was identified in 31 of 102 patients [30.4 %]. The area under the ROC curve for detecting radiographic edema by ONSD was 0.785 [95 % CI 0.695-0.874, p <0.001]. ONSD diameter of 0.57 cm was found to be the best cutoff threshold with a sensitivity 84 % and specificity 71 %, AUC 0.785 [95 % CI 0.695-0.874, p <0.001]. Using ONSD as a bedside test increased the post-test odds ratio [OR] for NTRCE by 2.89 times [positive likelihood ratio], whereas post-test OR for NTRCE decreased markedly given a negative ONSD test [ONSD measurement less than 0.57 cm]; negative likelihood ratio 0.22. CONCLUSIONS The use of ONSD as a bedside test in patients with non-traumatic coma has diagnostic value in identifying patients with non-traumatic radiographic cerebral edema.
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Affiliation(s)
- Nawal Salahuddin
- Adult Critical Care Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, 11211, Saudi Arabia.
| | - Alaa Mohamed
- Adult Critical Care Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, 11211, Saudi Arabia
| | - Nadia Alharbi
- Adult Critical Care Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, 11211, Saudi Arabia
| | - Hamad Ansari
- Adult Critical Care Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, 11211, Saudi Arabia
| | - Khaled J Zaza
- College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533, Saudi Arabia
| | - Qussay Marashly
- College of Medicine, Alfaisal University, P.O. Box 50927, Riyadh, 11533, Saudi Arabia
| | - Iqbal Hussain
- Adult Critical Care Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, 11211, Saudi Arabia
| | - Othman Solaiman
- Adult Critical Care Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, 11211, Saudi Arabia
| | | | - Khalid Maghrabi
- Adult Critical Care Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, 11211, Saudi Arabia
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Optic nerve sheath diameter on computed tomography not predictive of neurological status post-cardiac arrest. CAN J EMERG MED 2016; 19:181-185. [PMID: 27514585 DOI: 10.1017/cem.2016.348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Optic nerve sheath diameter (ONSD) measured on a head computed tomography (CT) has been suggested as a potential prognostic factor for poor neurological outcome after cardiac arrest. We performed a single centre retrospective cohort analysis to further investigate this relationship. METHODS All patients >18 years of age admitted to St. Paul's Hospital in Vancouver, Canada who survived a cardiac arrest and had a CT scan of the head within 48 hours were included in the analysis. RESULTS A total of 72 patients met inclusion criteria for the study; 54 (75.0%) of the patients had a poor neurological outcome, whereas 18 (25.0%) patients were discharged from the hospital with a good outcome. A CT head was obtained for patients in the good outcome group in a mean time of 9.3 hours (SD 10.0) compared to 10.2 hours (SD 11.2) for the poor outcome group (p=0.75). There was no difference in average ONSD observed between the two outcome groups (6.66 mm SD 0.78 v. 6.60 mm SD 0.82, p=0.77). Multiple logistic regression failed to show any association between ONSD and neurological outcome when adjusted for all other covariates (OR 1.32 95% CI 0.40-4.34, p=0.65). Setting an ONSD threshold of >8 mm (OR 2.32, 95% CI 0.14-39.40, p=0.55) or >7 mm (OR 0.28, 95% CI 0.03-2.77, p=0.28) also failed to show any association on neurological outcome. CONCLUSION There was no observed difference in ONSD between those with a good neurological outcome and those with a poor outcome. ONSD was not an independent predictor of poor neurological outcome.
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Robba C, Bacigaluppi S, Cardim D, Donnelly J, Bertuccio A, Czosnyka M. Non-invasive assessment of intracranial pressure. Acta Neurol Scand 2016; 134:4-21. [PMID: 26515159 DOI: 10.1111/ane.12527] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 11/29/2022]
Abstract
Monitoring of intracranial pressure (ICP) is invaluable in the management of neurosurgical and neurological critically ill patients. Invasive measurement of ventricular or parenchymal pressure is considered the gold standard for accurate measurement of ICP but is not always possible due to certain risks. Therefore, the availability of accurate methods to non-invasively estimate ICP has the potential to improve the management of these vulnerable patients. This review provides a comparative description of different methods for non-invasive ICP measurement. Current methods are based on changes associated with increased ICP, both morphological (assessed with magnetic resonance, computed tomography, ultrasound, and fundoscopy) and physiological (assessed with transcranial and ophthalmic Doppler, tympanometry, near-infrared spectroscopy, electroencephalography, visual-evoked potentials, and otoacoustic emissions assessment). At present, none of the non-invasive techniques alone seem suitable as a substitute for invasive monitoring. However, following the present analysis and considerations upon each technique, we propose a possible flowchart based on the combination of non-invasive techniques including those characterizing morphologic changes (e.g., repetitive US measurements of ONSD) and those characterizing physiological changes (e.g., continuous TCD). Such an integrated approach, which still needs to be validated in clinical practice, could aid in deciding whether to place an invasive monitor, or how to titrate therapy when invasive ICP measurement is contraindicated or unavailable.
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Affiliation(s)
- C. Robba
- Neurosciences Critical Care Unit; Addenbrooke's Hospital; Cambridge United Kingdom
- Brain Physics Lab; Division of Neurosurgery; Department of Clinical Neurosciences; University of Cambridge; United Kingdom
| | - S. Bacigaluppi
- Department of Neurosurgery; Galliera Hospital; Genova Italy
| | - D. Cardim
- Brain Physics Lab; Division of Neurosurgery; Department of Clinical Neurosciences; University of Cambridge; United Kingdom
| | - J. Donnelly
- Brain Physics Lab; Division of Neurosurgery; Department of Clinical Neurosciences; University of Cambridge; United Kingdom
| | - A. Bertuccio
- Department of Neurosurgery; S. George's Hospital; University of London; United Kingdom
| | - M. Czosnyka
- Brain Physics Lab; Division of Neurosurgery; Department of Clinical Neurosciences; University of Cambridge; United Kingdom
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The Effect of Red Blood Cell Transfusion on Cerebral Autoregulation in Patients with Severe Traumatic Brain Injury. Neurocrit Care 2016; 23:210-6. [PMID: 25894454 DOI: 10.1007/s12028-015-0141-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Red blood cell (RBC) transfusion is associated with inconsistent changes in brain tissue oxygenation (PbO2). Previous studies have failed to consider alterations in cerebral autoregulation. Our objective was to investigate the effect of RBC transfusion on cerebral autoregulation, as measured by pressure reactivity index (PRx). METHODS Retrospective analysis of 28 severe traumatic brain injury (TBI) patients from a prospective registry between 2007 and 2014. We recorded hemoglobin (Hb) concentration, intracranial pressure, PbO2, cerebral perfusion pressure, PRx, and cerebral lactate/pyruvate ratio for 6 h before and after RBC transfusion. We also recorded body temperature, PaO2, PCO2, pH, and fraction of inspired oxygen. Subgroups of normoxia (PbO2 >20 mmHg) and hypoxia (PbO2 <20 mmHg) prior to transfusion were defined a priori. RESULTS The median age was 36 years [interquartile range (IQR) 27-49], 32% were female. The median admission Glasgow Coma score was 5 (IQR 4-9) and injury severity score was 16 (IQR 9-21). Overall, mean Hb concentration [80 g/L (SD 7) to 89 g/L (SD 8), p < 0.001] and PbO2 increased [23.5 mmHg (SD 8) to 25.0 mmHg (SD 9), p = 0.033] following transfusion. PRx increased post-transfusion [0.028 (SD 0.29) to 0.11 (SD 0.24), p = 0.034], indicating worsening cerebrovascular pressure reactivity. In patients with mean PbO2 >20 mmHg pre-transfusion (n = 20), the PRx increased significantly [-0.052 (SD 0.24) to 0.079 (SD 0.22), p = 0.007] but did not change in patients with PbO2 <20 mmHg: PRx [0.22 (SD 0.34) to 0.18 (SD 0.30), p = 0.36]. CONCLUSION RBC transfusion in severe TBI patients results in worsening PRx, indicating impaired cerebral autoregulation.
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Chelly J, Deye N, Guichard JP, Vodovar D, Vong L, Jochmans S, Thieulot-Rolin N, Sy O, Serbource-Goguel J, Vinsonneau C, Megarbane B, Vivien B, Tazarourte K, Monchi M. The optic nerve sheath diameter as a useful tool for early prediction of outcome after cardiac arrest: A prospective pilot study. Resuscitation 2016; 103:7-13. [PMID: 26995663 DOI: 10.1016/j.resuscitation.2016.03.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/18/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Optic nerve sheath diameter (ONSD) measurement could detect increased intracranial pressure, and might predict outcome in post-cardiac arrest (CA) patients. We assessed the ability of bedside ONSD ultrasonographic measurement performed within day 1 after CA occurrence to predict in-hospital survival in patients treated with therapeutic hypothermia (TH). METHODS In two French ICUs, a prospective study included all consecutive patients with CA without traumatic or neurological etiology, successfully resuscitated and TH-treated. ONSD measurements were performed on day 1, 2, and 3 (ONSD1, 2, 3 respectively) after return of spontaneous circulation. All records were registered according to Utstein style. RESULTS ONSD1, 2, 3 were assessed in 36, 21, and 14 patients respectively. 19/36 patients (53%) were discharged alive from hospital, including 14/36 (39%) with favorable neurological outcome (Cerebral Performance Category [CPC] score 1-2). Survivors and non-survivors were similar regarding age, sex, cardiovascular risk factors, location and etiology of CA, simplified acute physiology score II, occurrence of post-CA shock, and clinical parameters collected during ONSD measurements. Median ONSD1 was significantly larger in non-survivors versus survivors (7.2mm [interquartile: 6.8-7.4] versus 6.5mm [interquartile: 6.0-6.8]; p=0.008). After adjustment on predictive factors, ONSD1 was significantly associated with in-hospital mortality (OR 6.3; 95%CI [1.05-40] per mm of ONSD1 above 5.5mm; p=0.03), and CPC score (OR for 1 point increase in CPC score: 3.2; 95%CI [1.2-9.4] per mm of ONSD1 above 5.5mm; p=0.03). ONSD1 was significantly correlated with brain edema assessed by the cerebrum gray matter attenuation to white matter attenuation ratio, measured by the brain computed tomography scan performed on admission in 20 patients (Spearman rho=-0.5, p=0.04). CONCLUSIONS ONSD seems a promising tool to early assess outcome in post-CA patients treated with TH.
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Affiliation(s)
- Jonathan Chelly
- Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France.
| | - Nicolas Deye
- Medical and Toxicological Intensive Care Unit, Groupe Hospitalier Lariboisière - Saint Louis - Fernand Widal, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75545 Paris, France; INSERM U942, Groupe Hospitalier Lariboisière - Saint Louis - Fernand Widal, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75545 Paris, France
| | - Jean-Pierre Guichard
- Department of Radiology, Groupe Hospitalier Lariboisière - Saint Louis - Fernand Widal, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75545 Paris, France
| | - Dominique Vodovar
- Medical and Toxicological Intensive Care Unit, Groupe Hospitalier Lariboisière - Saint Louis - Fernand Widal, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75545 Paris, France
| | - Ly Vong
- Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France
| | - Sebastien Jochmans
- Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France
| | | | - Oumar Sy
- Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France
| | - Jean Serbource-Goguel
- Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France
| | - Christophe Vinsonneau
- Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France
| | - Bruno Megarbane
- Medical and Toxicological Intensive Care Unit, Groupe Hospitalier Lariboisière - Saint Louis - Fernand Widal, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75545 Paris, France
| | - Benoit Vivien
- SAMU 75, Hôpital Necker - Enfants Malades - Assistance Publique des Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France
| | - Karim Tazarourte
- SAMU 77, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France
| | - Merhan Monchi
- Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France
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Tarzamni MK, Derakhshan B, Meshkini A, Merat H, Fouladi DF, Mostafazadeh S, Rezakhah A. The diagnostic performance of ultrasonographic optic nerve sheath diameter and color Doppler indices of the ophthalmic arteries in detecting elevated intracranial pressure. Clin Neurol Neurosurg 2015; 141:82-8. [PMID: 26771156 DOI: 10.1016/j.clineuro.2015.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/02/2015] [Accepted: 12/10/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To assess the diagnostic accuracy of ultrasonographic optic nerve sheath diameter (ONSD) measurement and color Doppler indices of the ophthalmic arteries in detecting elevated intracranial pressure (ICP). PATIENTS AND METHODS A total 60 patients with (cases, n=30) and without (controls, n=30) acute clinical and computed tomographic findings of elevated ICP due to intracranial mass/hemorrhage were recruited from a teaching hospital. The mean binocular and maximum ultrasonographic ONSDs, as well as the mean binocular Doppler ultrasound waveform indices of the ophthalmic arteries including pulsatility index (PI), resistive index (RI), end-systolic velocity (ESV), peak systolic velocity (PSV) and end-diastolic velocity (EDV) were compared between the two groups. RESULTS Compared to controls, the case group had significantly higher mean binocular ONSD (5.48 ± 0.52 mm vs. 4.09 ± 0.22 mm, p<0.001), maximum ONSD (5.63 ± 0.55 mm vs. 4.16 ± 0.23 mm, p<0.001), mean PI (1.53 ± 0.16 vs. 1.45 ± 0.20, p=0.01), and mean RI (0.76 ± 0.07 vs. 0.73 ± 0.04, p=0.01). The mean EDV, in contrast, was significantly higher in controls (8.55 ± 3.09 m/s vs. 7.17 ± 2.61 m/s, p=0.01). The two groups were comparable for the mean PSV (30.73 ± 7.93 m/s in cases vs. 32.27 ± 10.39 m/s in controls, p=0.36). Among the mentioned variables, the mean binocular ONSD was the most accurate parameter in detecting elevated ICP (sensitivity and specificity of 100%, cut-off point=4.53 mm). The Doppler indices were only moderately accurate (sensitivity: 56.7-60%, specificity: 63.3-76.7%). CONCLUSION While the ultrasonographic mean binocular ONSD (>4.53 mm) was completely accurate in detecting elevated ICP, color Doppler indices of the ophthalmic arteries were of limited value.
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Affiliation(s)
- Mohammad Kazem Tarzamni
- Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Derakhshan
- Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Meshkini
- Department of Neurosurgery, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Merat
- Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Samira Mostafazadeh
- Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Rezakhah
- Department of Radiology, Imam Reza Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
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Shirodkar CG, Munta K, Rao SM, Mahesh MU. Correlation of measurement of optic nerve sheath diameter using ultrasound with magnetic resonance imaging. Indian J Crit Care Med 2015; 19:466-70. [PMID: 26321806 PMCID: PMC4548416 DOI: 10.4103/0972-5229.162465] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and Aims: Analysis to correlate the measurements of optic nerve sheath diameter (ONSD) obtained by using ultrasound to magnetic resonance imaging (MRI) techniques in order to establish the accuracy of ocular sonography as a noninvasive modality for detecting raised intracranial pressure (ICP). Materials and Methods: A prospective, observational study was performed in 100 cases of adult meningoencephalitis patients admitted to Intensive Care Unit in whom MRI was performed for neurodiagnosis. ONSD was measured in such patients, 3 mm behind the globe in each eye. A mean binocular ONSD >4.6 mm in female and 4.8 mm in male was taken as cut-off values for diagnosing raised ICP. This was compared with ONSD measured on T2-weighted MRI image measured 3 mm behind the globe. The reading obtained from both the methods were compared with Bland–Altman analysis for correlation and the findings were tabulated. Results: The mean ONSD values measured with ultrasonography (USG) and MRI for female were 5.48 ± 0.43 mm and 5.68 ± 0.44 mm and for male were 5.40 ± 0.37 mm and 5.56 ± 0.38 mm, respectively. The mean age of the female and male was 53.90 ± 17.84 and 56.06 ± 15.67 years, respectively. On comparing ultrasound with MRI-derived ONSD values, we found acceptable agreement between both methods for measurements at a depth of 3 mm (r = 0.02, P < 0.001). Conclusion: In our study, we have found a good correlation between ocular USG and MRI of ONSD. The study has shown agreement with the fact that ocular sonography can be used as a noninvasive tool for detecting raised ICP with accuracy.
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Affiliation(s)
- Chetan G Shirodkar
- Department of Critical Care Medicine, Yashoda Super Speciality Hospital, Hyderabad, Telangana, India
| | - Kartik Munta
- Department of Critical Care Medicine, Yashoda Super Speciality Hospital, Hyderabad, Telangana, India
| | - S Manimala Rao
- Department of Critical Care Medicine, Yashoda Super Speciality Hospital, Hyderabad, Telangana, India
| | - M Uma Mahesh
- Department of Radiology, Yashoda Super Speciality Hospital, Hyderabad, Telangana, India
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Recommendations for the use of multimodal monitoring in the neurointensive care unit. Curr Opin Crit Care 2015; 21:113-9. [DOI: 10.1097/mcc.0000000000000179] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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