Association of optic nerve sheath diameter in ocular ultrasound with prognosis in patients presenting with acute stroke symptoms

Prognostic Value of Optic Nerve Sheath Diameters after Acute Ischemic Stroke According to Slice Thickness on Computed Tomography

The optic nerve sheath diameter (ONSD) can predict intracranial pressure and outcomes in neurological disease, but it remains unclear whether a small ONSD can be accurately measured on routine CT images with a slice thickness of approximately 4-5 mm. We measured the ONSD and ONSD/eyeball transverse diameter (ETD) ratio on routine-slice (4 mm) and thin-slice (0.6-0.75 mm) brain CT images from initial scans of acute ischemic stroke (AIS) patients. ONSD-related variables, National Institutes of Health Stroke Scale (NIHSS) scores, and age were compared between good (modified Rankin Scale [mRS] ≤ 2) and poor (mRS > 2) outcomes at discharge. Among 155 patients, 38 had poor outcomes. The thin-slice ONSD was different between outcome groups (p = 0.047), while the routine-slice ONSD showed no difference. The area under the curve (AUC) values for the ONSD and ONSD/ETD were 0.58 (95% CI, 0.49-0.66) and 0.58 (95% CI, 0.50-0.66) on the routine-slice CT, and 0.60 (95% CI, 0.52-0.68) and 0.62 (95% CI, 0.54-0.69) on the thin-slice CT. The thin-slice ONSD/ETD ratio correlated with initial NIHSS scores (r = 0.225, p = 0.005). After adjusting for NIHSS scores and age, ONSD-related variables were not associated with outcomes, and adding them to a model with NIHSS scores and age did not improve performance (all p-values > 0.05). Although ONSD measurements were not an independent outcome predictor, they correlated with stroke severity, and the thin-slice ONSD provided a slightly better prognostic performance than the routine-slice ONSD.

Dilated optic nerve sheath by ultrasound predicts mortality among patients with acute intracerebral hemorrhage

BACKGROUND

Intracerebral hemorrhage (ICH) is a deadly disease and increased intracranial pressure (ICP) is associated with worse outcomes in this context.

OBJECTIVE

We evaluated whether dilated optic nerve sheath diameter (ONSD) depicted by optic nerve ultrasound (ONUS) at hospital admission has prognostic value as a predictor of mortality at 90 days.

METHODS

Prospective multicenter study of acute supratentorial primary ICH patients consecutively recruited from two tertiary stroke centers. Optic nerve ultrasound and cranial computed tomography (CT) scans were performed at hospital admission and blindly reviewed. The primary outcome was mortality at 90-days. Multivariate logistic regression, ROC curve, and C-statistics were used to identify independent predictors of mortality.

RESULTS

Between July 2014 and July 2016, 57 patients were evaluated. Among those, 13 were excluded and 44 were recruited into the trial. Their mean age was 62.3 ± 13.1 years and 12 (27.3%) were female. On univariate analysis, ICH volume on cranial CT scan, ICH ipsilateral ONSD, Glasgow coma scale, National Institute of Health Stroke Scale (NIHSS) and glucose on admission, and also diabetes mellitus and current nonsmoking were predictors of mortality. After multivariate analysis, ipsilateral ONSD (odds ratio [OR]: 6.24; 95% confidence interval [CI]: 1.18-33.01; p = 0.03) was an independent predictor of mortality, even after adjustment for other relevant prognostic factors. The best ipsilateral ONSD cutoff was 5.6mm (sensitivity 72% and specificity 83%) with an AUC of 0.71 (p = 0.02) for predicting mortality at 90 days.

CONCLUSION

Optic nerve ultrasound is a noninvasive, bedside, low-cost technique that can be used to identify increased ICP in acute supratentorial primary ICH patients. Among these patients, dilated ONSD is an independent predictor of mortality at 90 days.

Prognostic role of optic nerve sheath diameter in stroke in emergency department, A case control study

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.

Ultrasonic optic nerve sheath diameter could improve the prognosis of acute ischemic stroke in the intensive care unit

Objectives: Stroke patients with high intracranial pressure (ICP) may have poor prognosis. Non-invasive ultrasonic optic nerve sheath diameter (ONSD) could evaluate increased ICP. To investigate whether ONSD is valuable for prognosis of patients with acute ischemic stroke (AIS). Methods: AIS receiving intensive care were recruited with the Glasgow Coma Scale (GCS) score. Patients in group A underwent ultrasonic ONSD to assess ICP voluntarily, whereas group B without ONSD. Patients were followed up at discharge and once a week for 3 months with Glasgow Outcome Scale (GOS) score (four to five scores indicated good prognosis and one to three scores indicated poor prognosis). Results: Forty-nine patients were included. GCS scores did not differ significantly between groups A (26 patients) and B (8 ± 3 vs. 7 ± 3, p < 0.05). In group A, ONSD was 5.01 ± 0.48 mm, which correlated with GCS score (p < 0.05). At discharge, the GOS score was higher in group A than in group B (3.35 ± 1.35 vs. 2.57 ± 1.121, p = 0.034). The proportion of patients with a good prognosis was higher in group A than in group B (46.2% vs. 13.0%, p = 0.006). At discharge and after 3 months of follow-up, ONSD at admission was correlated with the GOS score in group A (r = -0.648 [p < 0.05] and -0.731 [p < 0.05], respectively). After 3 months of follow-up, the GOS score was higher in group A than group B (3.00 ± 1.673 vs. 2.04 ± 1.430, p < 0.05). The proportion of patients with a good prognosis was higher in group A than in group B (46.2% vs. 21.2%, p = 0.039). The Kaplan-Meier curve showed a higher rate of good prognosis in group A than in group B. ONSD (p < 0.05) was an independent predictor of poor prognosis. Conclusion: Non-invasive ultrasonic ONSD could be useful in improving the prognosis of patients with AIS receiving intensive care.

Optic nerve sheath diameter in patients with hepatic encephalopathy

BACKGROUND

This study aims to reveal whether the optic nerve sheath diameter (ONSD) increases in hepatic encephalopathy (HE) patients, and to determine ONSD is associated with the poor prognosis of patients with HE.

METHODS AND MATERIAL

In this retrospective case-control study, HE patients who underwent cranial computerized tomography (CT) were included in the case group; and the patients who underwent CT for other reasons for the same age and gender and were normally interpreted were included in the control group. ONSD measurements in the case and control groups and clinical grades of HE with in-hospital mortality and ONSD measurements were compared in the case group.

RESULTS

This study was done with 74 acute HE patients and 74 control patients. The mean age was 62.9 ± 11.0 years and 67.6% of patients were male in both groups. The ONSD in the case group was higher than the control group (5.27-mm ± 0.82 vs 4.73 mm ± 0.57, p <0.001). In the case group, the ONSD was 5.30 mm ± 0.87 in survivors, and 5.21 ± 0.65 in non-survivors (P = 0.670). There was no significant difference between the West Haven HE grade (P = 0.348) and Child-Pugh Score (P = 0.505) with ONSD measurements.

CONCLUSION

We have shown that ONSD increases in HE patients compared to the control group. ONSD was not related to the Child-Pugh Score, HE grade, and in-hospital mortality.

The role of optic nerve sheath diameter measurement on CT in differentiating transient ischemic attack and acute ischemic stroke

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.

Ultrasound measurement of the optic nerve sheath diameter in traumatic brain injury: a narrative review

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.

Ultrasound of Optic Nerve Sheath Diameter and Stroke Outcomes

Supplemental Digital Content is available in the text.

We aimed at utilizing ocular ultrasound to determine its utility in predicting outcomes among stroke patients.