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Fan WZ, Jiang JR, Zang HL, Shen XH, Cheng H, Yang WJ, Wang H, Jing LX. Advancements in Ultrasound Techniques for Evaluating Intracranial Pressure Through Optic Nerve Sheath Diameter Measurement. World Neurosurg 2024; 189:285-290. [PMID: 38906474 DOI: 10.1016/j.wneu.2024.06.087] [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: 03/12/2024] [Revised: 06/16/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024]
Abstract
Elevated intracranial pressure (ICP) in patients with cerebral lesions has garnered considerable attention in research. It often manifests as a common symptom in conditions such as intracranial tumors, intracerebral hemorrhage, and cerebral edema. This paper provides an overview of ICP concepts, discusses the advantages and disadvantages of traditional monitoring methods, explores the physiological and anatomical aspects of the optic nerve sheath, examines the utility of ultrasound measurement of optic nerve sheath diameter (ONSD) in both nervous system and nonnervous system disorders, and outlines the cutoff values and normal ranges for assessing elevated ICP using ultrasound measurement of ONSD. The review underscores ultrasound measurement of ONSD as a promising noninvasive, safe, straightforward, and repeatable examination technique for various diseases. Nevertheless, the lack of standardized cutoff values for elevated ICP remains a challenge. Summarizing studies on optic nerve sheaths is crucial for enhancing the efficacy of ultrasound measurement of ONSD in assessing ICP.
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Affiliation(s)
- Wei-Ze Fan
- Department of The Fifth Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jun-Rong Jiang
- Department of Geriatric Medicine, Taizhou Hospital of Zhejiang Province, Taizhou, China
| | - Hui-Ling Zang
- Department of Emergency, Hebei General Hospital, Shijiazhuang, China
| | - Xiao-Hui Shen
- Department of Intensive Care Unit, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Hui Cheng
- Department of Intensive Care Unit, Shijiazhuang People's Hospital, Shijiazhuang, China.
| | - Wen-Juan Yang
- Department of Component Preparation Section, Hebei Province Blood Center, Shijiazhuang, China
| | - Hui Wang
- Department of Intensive Care Unit, Shijiazhuang People's Hospital, Shijiazhuang, China
| | - Li-Xing Jing
- Department of Intensive Care Unit, Shijiazhuang People's Hospital, Shijiazhuang, China
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Kocaşaban DÜ, Güler S, Günaydin YK. Effect of Target Temperature Management on Optic Nerve Sheath Diameter in Post-Cardiac Arrest Patients. Ther Hypothermia Temp Manag 2024. [PMID: 38608231 DOI: 10.1089/ther.2024.0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024] Open
Abstract
Target Temperature Management (TTM) is a procedure used in post-cardiac arrest (CA) patients to reduce mortality and morbidity. The goal of this study was to investigate the link between intracranial pressure (ICP) and optic nerve sheath diameter (ONSD) in this patient group, which has a high mortality rate, despite TTM, and to see if ONSD may be used to predict mortality. The research was designed to be a retrospective observational study. The study comprised patients who were followed up on in a tertiary intensive care unit, had post-CA TTM, and had brain computed tomography (BCT) before and 0-6 hours after TTM. ONSD measurements were acquired from patients' BCT images recorded before and after TTM. The difference in pre-TTM ONSD and post-TTM ONSD measurements in all post-CA patients, as well as the difference in pre-TTM ONSD and post-TTM ONSD measurements in surviving and deceased patients, was compared. The study involved 33 participants. The patients' average age was 60.58-12.39 years, and 75.8% were male. Around 51.5% of the patients died. When the pre-TTM and post-TTM ONSDs of all patients were compared, there was no statistically significant difference (p = 0.856). When the percentage change (Δ) values between the post-TTM ONSD and pre-TTM ONSD and post-TTM ONSD measures of the surviving patients and the deceased patients were compared, a difference was observed (p < 0.01). Increased ICP in post-CA patients is a significant clinical issue associated with mortality and poor neurological prognosis. ONSD measurement may be useful in monitoring ICP, which may rise, despite TTM, and higher ONSD measurements may be used as an indicator for mortality in post-CA patients, who have received TTM.
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Affiliation(s)
- Dilber Üçöz Kocaşaban
- Department of Emergency Medicine, Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Sertaç Güler
- Department of Emergency Medicine, Ankara Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Yahya Kemal Günaydin
- Department of Emergency Medicine, Ankara Training and Research Hospital, University of Health Sciences, Ankara, 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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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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Oliveira BDD, Lima FO, Homem HDC, Figueirêdo AA, Freire VMB, Maia Carvalho FM. Optic Nerve Sheath Diameter Detects Intracranial Hypertension in Acute Malignant Middle Cerebral Artery Infarction. J Stroke Cerebrovasc Dis 2022; 31:106276. [PMID: 35032755 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106276] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/15/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To evaluate optic nerve sheath diameter in the acute phase of patients with malignant ischemic middle cerebral artery stroke submitted or not to decompressive craniectomy surgery. MATERIALS AND METHODS Forty patients participated in the study and were evaluated bilaterally by ultrasound on admission and at 24h, 48h and 72 h after admission. Optic nerve sheath diameter values were correlated with tomographic and/or clinical criteria compatible with severe intracranial hypertension. RESULTS A Receiver Operating Characteristic curve was drawn for each eye, determining a cut-off value for severe intracranial hypertension in the right eye of 5.4 mm (sensitivity: 62%; specificity: 100%; AUC: 0.82) and in the left eye 5.4 mm (sensitivity: 76%; specificity: 84%; AUC: 0.77). In patients undergoing craniectomy, there was a decrease in the mean value of 1.04mm in the right eye (pre: 5.84 ± 0.47 mm; post: 4.80 ± 0.84 mm; p = 0.001), while in the left, it decreased around 0.86mm (pre: 5.59 ± 0.69 mm; post: 4.73 ± 0.74 mm; p = 0.003). Patients with fatal outcome showed a persistent high mean ocular nerve sheath diameter. CONCLUSIONS Monitoring optic nerve sheath by ultrasound can be considered a reliable method for identifying severe intracranial hypertension in patients with large vessel occlusion, as well as for monitoring patients undergoing craniectomy. Additional studies will be necessary to include this parameter in craniectomy indication algorithms in the future.
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Affiliation(s)
- Breno Douglas Dantas Oliveira
- Medical Sciences Postgraduation Program, Universidade de Fortaleza (UNIFOR), Fortaleza, Ceará, 60811-905, Brazil; Medicine Program, Universidade de Fortaleza (UNIFOR), Fortaleza, Ceará, 60811-905, Brazil
| | | | - Hellen do Carm Homem
- Neurology Department, Hospital Geral de Fortaleza, Fortaleza, Ceará, 60150-160, Brazil
| | | | | | - Fernanda Martins Maia Carvalho
- Medical Sciences Postgraduation Program, Universidade de Fortaleza (UNIFOR), Fortaleza, Ceará, 60811-905, Brazil; Neurology Department, Hospital Geral de Fortaleza, Fortaleza, Ceará, 60150-160, Brazil.
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Prognostic Role of Optic Nerve Sheath Diameter for Neurological Outcomes in Post-Cardiac Arrest Patients: A Systematic Review and Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5219367. [PMID: 33426054 PMCID: PMC7775140 DOI: 10.1155/2020/5219367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 12/06/2020] [Accepted: 12/14/2020] [Indexed: 02/08/2023]
Abstract
Objective The present study investigated whether optic nerve sheath diameter (ONSD) could be used to predict neurological outcomes in post-cardiac arrest (CA) patients. Methods We performed a comprehensive literature search in the Cochrane Library, ScienceDirect, PubMed, and Web of Science from inception to June 2020 for eligible articles. Stata 14.0 software was used to calculate the pooled odds ratios (ORs) and 95% confidence intervals (95% CIs), sensitivity, specificity, summary receiver operating characteristic (SROC) curve, subgroup analysis, sensitivity analysis, and publication bias. Results Eight studies involving 473 patients were considered eligible for this meta-analysis. The pooled result using a random-effects model showed that broadened ONSD is associated with poor neurological outcomes in post-CA patients (OR = 15.62, 95% CI: 5.50-44.34, P < 0.001; I 2 = 58.4%, P = 0.018), with a sensibility of 0.60 (95% CI: 0.45-0.73) and specificity of 0.94 (95% CI: 0.83-0.98). The area under the curve of the SROC curve for ONSD was 0.87 (95% CI: 0.84-0.90). Subgroup analysis revealed that sample size and time of ONSD measurement may be the source of heterogeneity. Sensitivity analysis demonstrated the stability of the results of this meta-analysis. No publication bias using Deeks' funnel plot was noted across the studies (P = 0.23). Conclusion This meta-analysis confirmed that ONSD can be used to predict neurological outcomes in post-CA patients.
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Güzeldağ S, Yılmaz G, Tuna M, Altuntaş M, Özdemir M. Measuring the Optic Nerve Sheath Diameter with Ultrasound in Acute Middle Cerebral Artery Stroke Patients. J Stroke Cerebrovasc Dis 2020; 30:105523. [PMID: 33307289 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/21/2020] [Accepted: 11/30/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Measurement of the optic nerve sheath diameter (ONSD) with ultrasound enables non-invasive and indirect assessment of increased intracranial pressure (ICP). Although most of the studies were employed with traumatic brain injury patients, it's increasingly popular in acute ischemic stroke (AIS) studies. OBJECTIVES Evaluating whether using ONSD as a follow-up measurement would help monitor the thrombolytic therapy (TT) effectiveness and determine the high-risk patients for malignant middle cerebral artery (MCA) syndrome. METHODS This prospective observational study was conducted between August 1, 2019, and February 1, 2020, in a tertiary hospital. Forty-four patients were eligible. We determined the TT moment as the time when the first ocular ultrasound measurement would be made (time 0). Also, we decided on the 24th h after the treatment as the time to perform the second ocular ultrasound measurement (time 24). The National Institute of Health Stroke Scale (NIHSS), the Glasgow Coma Scale (GCS), and the Alberta Stroke Program Early Computed Tomography (ASPECT) scores were evaluated blindly at the time-0 and the time-24. The cut-off value of ONSD was 0.55 mm. RESULTS There was no difference in ONSD results before and after the TT (p = 0.414). But, patients with an equal or higher value than cut-off had an increased risk for complications such as malignant-MCA, bleeding, seizure, etc. (p = 0.05). Malignant-MCA was observed in four patients with higher ONSD values. At the time-24, NIHSS decreased, GCS and ASPECT scores increased. Finally, ONSD was positively correlated with the NIHSS and negatively correlated with the GCS at the time-24. CONCLUSIONS Monitoring ONSD values in both the emergency department and the intensive care unit may be useful in the early diagnosis of MCA stroke complications and the follow-up of TT's effectiveness.
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Affiliation(s)
- Seda Güzeldağ
- Department of Neurointensive Care, Kayseri City Hospital, Kayseri, Turkey.
| | - Gökhan Yılmaz
- Department of Emergency Medicine, Kayseri City Hospital, Kayseri, Turkey
| | - Merva Tuna
- Department of Neurology, Kayseri City Hospital, Kayseri, Turkey
| | - Mükerrem Altuntaş
- Department of Emergency Medicine, Kayseri City Hospital, Kayseri, Turkey
| | - Mustafa Özdemir
- Department of Radiology, Kayseri City Hospital, Kayseri, Turkey
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Özdemir A, Şahan MH, Asal N, İnal M, Güngüneş A. Evaluation of the medial rectus muscle and optic nerve using strain and shear wave elastography in Graves' patients. Jpn J Radiol 2020; 38:1028-1035. [PMID: 32638278 DOI: 10.1007/s11604-020-01014-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/27/2020] [Indexed: 01/25/2023]
Abstract
PURPOSE The purpose of this study was to describe the elastic properties of the medial rectus muscle and optic nerve in Graves' patients without clinically apparent ophthalmopathy using strain elastography (SE) and shear wave elastography (SWE) and to determine whether these elastic properties could be used to aid in the diagnosis of the medial rectus muscle or optic nerve involvement. MATERIALS AND METHODS Thirty participants diagnosed with Graves' disease without ophthalmopathy and 30 healthy volunteers (control group) were prospectively examined between November 2018 and August 2019. SE and SWE findings in both groups were compared using the χ2 test and the independent samples t test. RESULTS A statistically significant softening of the medial rectus muscle was observed in the SE patterns of the Graves' patients (p = 0.009). A statistically appreciable distinction was observed between the medial rectus muscle (7.64 ± 2.1 and 9.20 ± 1.7 kPa, p = 0.000) and the optic nerve (8.35 ± 2.8 and 9.37 ± 1.5 kPa, p = 0.019) in the SWE modulus of the Graves' patients and healthy volunteers. CONCLUSION SE and SWE can be used to identify structural alterations to the medial rectus muscle and optic nerve before clinically apparent Graves' ophthalmopathy has developed.
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Affiliation(s)
- Adnan Özdemir
- Faculty of Medicine, Radiology Department, Kirikkale University, Kirikkale, Turkey.
| | - Mehmet H Şahan
- Faculty of Medicine, Radiology Department, Gaziantep University, Gaziantep, Turkey
| | - Neşe Asal
- Faculty of Medicine, Radiology Department, Kirikkale University, Kirikkale, Turkey
| | - Mikail İnal
- Faculty of Medicine, Radiology Department, Kirikkale University, Kirikkale, Turkey
| | - Aşkın Güngüneş
- Faculty of Medicine, Endocrinology and Metabolism Department, Kirikkale University, Kirikkale, Turkey
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Lovrenčić-Huzjan A, Bosnar-Puretić M, Hustić I, Kobasić I, Budišić M, Ćorić L, Roje-Bedeković M. OPTIC NERVE SHEATH SONOGRAPHY IS A PROMISING TOOL FOR ASSESSMENT OF RAISED INTRACRANIAL PRESSURE IN PATIENTS ADMITTED TO NEUROLOGICAL INTENSIVE CARE UNIT. Acta Clin Croat 2020; 59:50-54. [PMID: 32724274 PMCID: PMC7382884 DOI: 10.20471/acc.2020.59.01.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Optic nerve sheath diameter (ONSD) enlargement is detectable in traumatic brain injury patients with raised intracranial pressure (ICP). The aim was to assess its value in neurological patients suspected to have increased ICP. Patient clinical imaging data and hospitalization outcome were analyzed. Patients were divided into groups according to brain pathology and level of consciousness with Glasgow Coma Score (GCS). Poor hospitalization outcome was assessed by modified Rankin scale (mRS) >3. Data obtained by ocular sonography performed in acute setting were compared with data of 100 control subjects. Data were expressed as mean ± SD. Intergroup comparison was performed by Student’s t-test. Data of 34 patients (63+16 years) were suitable for analysis, including 8 primary intracerebral hemorrhage (PICH), 8 subarachnoid hemorrhage (SAH), 12 PICH or SAH and intraventricular hemorrhage (IVH), 4 tumors and 2 ischemic strokes. The mean ONSD was 5.86+0.69 mm in patients versus 4.38+0.41 mm in controls (p<0.01). ONSD was 6.28+0.61 mm in patients with GCS <8 and 5.77+0.55 mm in other patients (p<0.05). ONSD was 5.72+0.59 mm in PICH versus 6.20+0.65 mm in PICH/SAH with IVH (p=0.1). ONSD was 5.73+0.38 mm in SAH in comparison to PICH/SAH with IVH (p=0.05). There was no statistically significant difference in optic nerve diameter between patients and controls (2.48+0.28 mm vs. 2.39+0.33 mm; p>0.05). Pronounced enlargement of ONSD was observed in patients with ICH or SAH with IVH, and in patients with GCS <8. Enlarged ONSD was associated with poor neurological outcome (mRS >3).
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Affiliation(s)
- Arijana Lovrenčić-Huzjan
- 1Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3University of Zagreb, School of Dental Medicine, Zagreb, Croatia
| | - Marijana Bosnar-Puretić
- 1Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3University of Zagreb, School of Dental Medicine, Zagreb, Croatia
| | - Ivana Hustić
- 1Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3University of Zagreb, School of Dental Medicine, Zagreb, Croatia
| | - Ivana Kobasić
- 1Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3University of Zagreb, School of Dental Medicine, Zagreb, Croatia
| | - Mislav Budišić
- 1Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3University of Zagreb, School of Dental Medicine, Zagreb, Croatia
| | - Lejla Ćorić
- 1Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3University of Zagreb, School of Dental Medicine, Zagreb, Croatia
| | - Marina Roje-Bedeković
- 1Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3University of Zagreb, School of Dental Medicine, Zagreb, Croatia
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Lochner P, Czosnyka M, Naldi A, Lyros E, Pelosi P, Mathur S, Fassbender K, Robba C. Optic nerve sheath diameter: present and future perspectives for neurologists and critical care physicians. Neurol Sci 2019; 40:2447-2457. [PMID: 31367861 DOI: 10.1007/s10072-019-04015-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/16/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Estimation of intracranial pressure (ICP) may be helpful in the management of neurological critically ill patients. It has been shown that ultrasonography of the optic nerve sheath diameter (ONSD) is a reliable tool for non-invasive estimation of increased intracranial pressure (ICP) at hospital admission or in intensive care. Less is known about the estimation of increased ICP and usefulness of ONSD in the prehospital setting. The aim of this review was to elucidate both prevailing and novel applications of ONSD for neurologists and critical care physicians. METHODS In this review, we discuss the technique and the novel approach of ONSD measurement, the clinical applications of ONSD in neurology and critical care patients. RESULTS ONSD measurement is simple, easy to learn, and has diverse applications. ONSD has utility for ICP measurement in intracranial hemorrhage and ischemic stroke, meningitis and encephalitis, and idiopathic intracranial hypertension (IIH). It is also valuable for lesser known syndromes, where an increase of ICP is postulated, such as acute mountain sickness and posterior reversible encephalopathy syndrome. ONSD changes develop in inflammatory or ischemic optic neuropathies. Some papers demonstrate the usefulness of ONSD studies in symptomatic intracranial hypotension. CONCLUSIONS ONSD is a safe and low-cost bedside tool with the potential of screening patients who need other neuroimaging and those who may need an invasive measurement of ICP.
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Affiliation(s)
- Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany.
| | - Marek Czosnyka
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Andrea Naldi
- Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Epameinondas Lyros
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.,Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Shrey Mathur
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Klaus Fassbender
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
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Park JS, Cho Y, You Y, Min JH, Jeong W, Ahn HJ, Kang C, Yoo I, Ryu S, Lee J, Kim SW, Cho SU, Oh SK, Lee J, Lee IH. Optimal timing to measure optic nerve sheath diameter as a prognostic predictor in post-cardiac arrest patients treated with targeted temperature management. Resuscitation 2019; 143:173-179. [PMID: 31306717 DOI: 10.1016/j.resuscitation.2019.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/20/2019] [Accepted: 07/03/2019] [Indexed: 11/26/2022]
Abstract
AIM We evaluated the optimal timing of optic nerve sheath diameter (ONSD) measurement to predict neurologic outcome in post-cardiac arrest patients treated with target temperature management (TTM). METHODS This was a prospective single-centre observational study from April 2018 to March 2019. Good outcome was defined as the Glasgow-Pittsburgh cerebral performance categories (CPC) 1 or 2, and poor outcome as a CPC between 3 and 5. ONSD was measured initially after return of spontaneous circulation (ROSC) (ONSDinitial), at 24 h (ONSD24), 48 h (ONSD48), and 72 h (ONSD72) using ultrasonography. The receiver operating characteristic (ROC) curves and DeLong method were used to compare the values for predicting neurologic outcomes. RESULTS Out of the 36 patients enrolled, 18 had a good outcome. ONSD24, ONSD48, and ONSD72 were higher in the poor outcome group. The area under ROC curve of ONSD24 was 0.91 (95% confidence interval 0.77-0.98) in predicting poor neurologic outcomes. With a cut off value of 4.90 mm, ONSD24 had a sensitivity of 83.3% and a specificity of 94.4% in predicting poor neurologic outcomes. CONCLUSION Our findings demonstrate ONSD24 as a valuable tool to predict the neurologic outcome in post-cardiac arrest patients treated with TTM. Therefore, we recommend performing ONSD measurement using ultrasonography at 24 h after ROSC, rather than immediately after ROSC, to predict neurologic outcome in post-cardiac arrest patients treated with TTM.
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Affiliation(s)
- Jung Soo Park
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea; Department of Emergency Medicine, College of Medicine, Chungnam National University School of Medicine, 282, Mokdong-ro, Jung-gu, Daejeon, Republic of Korea
| | - Yongchul Cho
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Yeonho You
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea.
| | - Jin Hong Min
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Wonjoon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Hong Joon Ahn
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Changshin Kang
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Insool Yoo
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea; Department of Emergency Medicine, College of Medicine, Chungnam National University School of Medicine, 282, Mokdong-ro, Jung-gu, Daejeon, Republic of Korea
| | - Seung Ryu
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Jinwoong Lee
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Seung Whan Kim
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea; Department of Emergency Medicine, College of Medicine, Chungnam National University School of Medicine, 282, Mokdong-ro, Jung-gu, Daejeon, Republic of Korea
| | - Sung Uk Cho
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Se Kwang Oh
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - Junwan Lee
- Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea
| | - In Ho Lee
- Department of Radiology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea; Department of Radiology, College of Medicine, Chungnam National University School of Medicine, 282, Mokdong-ro, Jung-gu, Daejeon, Republic of Korea
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12
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Özdemir U, Çimen M, Güney T, Gürsel G. Validity and reliability of pocket-sized ultrasound devices in measurement of optic nerve sheath diameter in ICU patients. J Clin Monit Comput 2019; 34:597-605. [PMID: 31278545 PMCID: PMC7223003 DOI: 10.1007/s10877-019-00351-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/01/2019] [Indexed: 12/19/2022]
Abstract
The measurement of the optic nerve sheath diameter (ONSD) by ultrasonography (USG) is particularly important for intracranial pressure (ICP) monitoring when invasive measurements are not possible or are contraindicated. Standard USG (SUDs) devices can be bulky and may break down the workflow. The validity and reliability of pocket-sized USG devices (PSUDs) compared to SUDs for ONSD measurement has not been investigated, yet. We compared the reliability and validity of PSUDs with SUDs for ONSD measurement. 35 patients were included in the study. ONSD measurements with PSUDs and SUDs were performed by two clinicians as three different measurements in both sagittal and transverse axis of the eye. There was agreement between mean transverse ONSD (mtONSD), mean sagittal ONSD (msONSD), and mean ONSD(mONSD) values measured with each device according to Bland-Altman test (p = 0.166, p = 0.135, p = 0.066, respectively) with no proportional bias (p = 0.544, p = 0.868, p = 0.929, respectively). Intraclass correlation coefficients (ICC) were found to be greater than 0.7 for mtONSD, msONSD, and mONSD values measured by SUD (ICC = 0.790, ICC = 0.817, and ICC = 0.844, respectively). Similarly, for mtONSD, msONSD, and mONSD values measured by PSUD, ICC were found greater than 0.7 (ICC = 0.763, ICC = 0.814, and ICC = 0.843, respectively). There was no statistically significant difference between mtONSD and msONSD (p = 0.441 for SUD and p = 0.893 for PSUD). There was a good correlation between mtONSD and msONSD (r = 0.767 for SUD and r = 0.816 for PSUD). The total variance between three different measurements in the transverse and sagittal axis was ± 0.6 mm. PSUDs can be used with similar validity and reliability as SUDs for ONSD measurement.
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Affiliation(s)
- Uğur Özdemir
- Division of Critical Care Medicine, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey.
| | - Meltem Çimen
- Division of Critical Care Medicine, Department of Anesthesiology, Gazi University School of Medicine, Ankara, Turkey
| | - Tuba Güney
- Division of Critical Care Medicine, Department of Neurology, Gazi University School of Medicine, Ankara, Turkey
| | - Gül Gürsel
- Department of Pulmonary Critical Care Medicine, Gazi University School of Medicine, Ankara, Turkey
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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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Şahan MH, Doğan A, İnal M, Alpua M, Asal N. Evaluation of the Optic Nerve by Strain and Shear Wave Elastography in Patients With Migraine. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1153-1161. [PMID: 30578566 DOI: 10.1002/jum.14904] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/23/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To investigate the optic nerve's elastic properties using shear wave and strain elastography in patients with migraine compared to healthy individuals. METHODS The migraine group consisted of 30 patients (16 with visual auras and 14 without auras) who had previously had a diagnosis of migraine. These were age and sex matched with healthy participants to form the control group. The findings from shear wave and strain elastography in the groups were compared. The elastographic examination was performed with a 6-15-MHz multifrequency linear array transducer. RESULTS The evaluation involved 30 patients with migraine (3 male and 27 female), whose mean age ± SD was 34.63 ± 10 years, and 30 healthy participants (3 males, 27 females), whose mean age was 36.4 ± 10.5 years. In strain elasticity patterns, a statistically insignificant hardening of the optic nerve in the patients with migraine was observed (P = .052). Analysis of the shear wave elastic modulus values (9.8 ± 3.34 and 12.3 ± 5.25 kPa; P = .03) revealed that differences between the healthy participants and patients with migraine were statistically significant. The results for elasticity patterns and the shear modulus suggested that the differences between migraines with and without visual auras were insignificant (P > .05). A positive correlation was discovered between the duration of the disease and the shear modulus in the patients with migraine (r = 0.496; P < .01). CONCLUSIONS Histopathologic changes in the optic nerve may be seen in patients with migraine due to possible fibrotic changes. Elastographic techniques can be useful diagnostic tools for investigating these changes.
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Affiliation(s)
- Mehmet Hamdi Şahan
- Department of Radiology Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Adil Doğan
- Department of Radiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Mikail İnal
- Department of Radiology Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Murat Alpua
- Department of Neurology, Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
| | - Neşe Asal
- Department of Radiology Faculty of Medicine, Kirikkale University, Kirikkale, Turkey
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Robba C, Goffi A, Geeraerts T, Cardim D, Via G, Czosnyka M, Park S, Sarwal A, Padayachy L, Rasulo F, Citerio G. Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review. Intensive Care Med 2019; 45:913-927. [PMID: 31025061 DOI: 10.1007/s00134-019-05610-4] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 03/26/2019] [Indexed: 12/20/2022]
Abstract
Brain ultrasonography can be used to evaluate cerebral anatomy and pathology, as well as cerebral circulation through analysis of blood flow velocities. Transcranial colour-coded duplex sonography is a generally safe, repeatable, non-invasive, bedside technique that has a strong potential in neurocritical care patients in many clinical scenarios, including traumatic brain injury, aneurysmal subarachnoid haemorrhage, hydrocephalus, and the diagnosis of cerebral circulatory arrest. Furthermore, the clinical applications of this technique may extend to different settings, including the general intensive care unit and the emergency department. Its increasing use reflects a growing interest in non-invasive cerebral and systemic assessment. The aim of this manuscript is to provide an overview of the basic and advanced principles underlying brain ultrasonography, and to review the different techniques and different clinical applications of this approach in the monitoring and treatment of critically ill patients.
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Affiliation(s)
- Chiara Robba
- Department of Anaesthesia and Intensive Care, Ospedale Policlinico San Martino IRCCS, San Martino Policlinico Hospital, IRCCS for Oncology, University of Genoa, Largo Rosanna Benzi, 15, 16100, Genoa, Italy.
| | - Alberto Goffi
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Thomas Geeraerts
- Department of Anaesthesia and Intensive Care, University Hospital of Toulouse, Toulouse NeuroImaging Center (ToNIC), Inserm-UPS, University Toulouse 3-Paul Sabatier, Toulouse, France
| | - Danilo Cardim
- Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Gabriele Via
- Cardiac Anesthesia and Intensive Care, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Marek Czosnyka
- Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge Biomedical Campus, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Soojin Park
- Division of Critical Care and Hospitalist Neurology, Department of Neurology, Columbia University, New York, USA
| | - Aarti Sarwal
- Department of Neurology, Wake Forest Baptist Medical Center, Winston Salem, NC, USA
| | - Llewellyn Padayachy
- Department of Neurosurgery, Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Frank Rasulo
- Department of Anaesthesia, Intensive Care and Emergency Medicine, Spedali Civili University Hospital of Brescia, Brescia, Italy
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
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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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Ertl M, Weber S, Hammel G, Schroeder C, Krogias C. Transorbital Sonography for Early Prognostication of Hypoxic-Ischemic Encephalopathy After Cardiac Arrest. J Neuroimaging 2018; 28:542-548. [PMID: 29883008 DOI: 10.1111/jon.12528] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 05/19/2018] [Accepted: 05/21/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Early prognostication of the outcome in resuscitated post cardiac arrest (CA) patients remains challenging especially if treated with therapeutic hypothermia. Brain edema caused by hypoxic-ischemic encephalopathy (HIE) can indirectly be estimated by transorbital sonography (TOS) taking in account the optic nerve sheath diameter (ONSD). The prognostic value of this easy, safe, and reproducible technique was investigated in this study. METHODS A total of 49 patients, initially unconscious (Glasgow Coma Scale ≤6) after successful resuscitation, were enrolled into this prospective observational study. Sonographic ONSD measurements were performed twice on day of admission (day 0) and once on days 1 and 2 after CA. Beyond ONSD, established prognostic parameters like neuron specific enolase and gray-white matter ratios were assessed. Cerebral Performance Category (CPC) score served as outcome parameter. RESULTS A total of 15 (31.3%) patients had a good outcome (CPC-score 1-2), 8 patients (14.6%) had severe disability (CPC-score 3-4), and 26 (54.2%) had a fatal outcome (CPC-score 5). Already in the first measurement on day 0, nonsurvivors showed significantly higher ONSD values (P < .001). For predicting mortality, a threshold of 5.75 mm was calculated with a specificity of 100%. ONSD did not differ significantly depending on hypothermia (P = .7009). CONCLUSION Early and reliable prognostication of outcomes in patients with HIE can be simplified by ONSD values gathered with the use of TOS. Main advantages compared to other established markers are prognostication within the first 24 hours and independence from therapy with hypothermia. A higher level of accuracy can be reached by combining computed tomography (gray-to-white matter ratio values) and ONSD values.
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Affiliation(s)
- Michael Ertl
- Clinic for Neurology and Neurophysiology, Klinikum Augsburg, Augsburg, Germany
| | - Sarah Weber
- Clinic for Neurology and Neurophysiology, Klinikum Augsburg, Augsburg, Germany
| | - Gertrud Hammel
- Chair and Institute of Environmental Medicine, UNIKA-T, Technical University of Munich and Helmholtz Zentrum München, Augsburg, Germany.,CK-CARE, Christine Kühne - Center for Allergy and Research and Education, Davos, Switzerland
| | - Christoph Schroeder
- Department of Neurology, Medical Faculty, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Christos Krogias
- Clinic for Neurology and Neurophysiology, Klinikum Augsburg, Augsburg, Germany
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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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Inal M, Tan S, Demirkan S, Burulday V, Gündüz Ö, Örnek K. Evaluation of Optic Nerve with Strain and Shear Wave Elastography in Patients with Behçet's Disease and Healthy Subjects. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1348-1354. [PMID: 28450035 DOI: 10.1016/j.ultrasmedbio.2017.03.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/14/2017] [Accepted: 03/17/2017] [Indexed: 06/07/2023]
Abstract
The objective of this study was to investigate the elasticity characteristics of the optic nerve using strain and shear wave elastography in patients with Behçet's disease and to compare the results with those of healthy volunteers. Forty-six optic nerves from patients with Behçet's disease and 54 optic nerves from healthy volunteers were investigated prospectively in this study using strain and shear wave elastography. There was a statistically significant difference in terms of elasticity patterns between patients and healthy volunteers (p < 0.001). Elastographic images of healthy volunteers revealed most optic nerves to be type 3 (51.8%); however, type 2 (40.7%) and type 1 (7.5%) were also observed. Elastographic examination of Behçet's disease patients revealed type 2 in 52.2%, type 1 in 43.5% and type 3 in 4.3% of patients. Statistically significant differences were observed between patients and healthy volunteers in the analysis of shear wave elastography values (p < 0.001). Receiver operating characteristic curve analysis was perfect (0.933) (95% CI = 0.885-0.980), and a cutoff value of 16.5 kPa shear had very high sensitivity and specificity for the patient group. Strain and shear wave elastography findings for the optic nerves of patients with Behçet's disease were significantly different from those for healthy volunteers.
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Affiliation(s)
- Mikail Inal
- Department of Radiology, Faculty of Medicine, Kirikkale University, Yahsihan, Kirikkale, Turkey.
| | - Sinan Tan
- Department of Radiology, Faculty of Medicine, Kirikkale University, Yahsihan, Kirikkale, Turkey
| | - Serkan Demirkan
- Department of Dermatology and Venerology, Faculty of Medicine, Kirikkale University, Yahsihan, Kirikkale, Turkey
| | - Veysel Burulday
- Department of Radiology, Faculty of Medicine, Kirikkale University, Yahsihan, Kirikkale, Turkey
| | - Özgür Gündüz
- Department of Dermatology and Venerology, Faculty of Medicine, Kirikkale University, Yahsihan, Kirikkale, Turkey
| | - Kemal Örnek
- Department of Ophtalmology, Faculty of Medicine, Kirikkale University, Yahsihan, Kirikkale, Turkey
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21
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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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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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