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Lee HB, Oh SH, Jang J, Koo J, Bang HJ, Lee MH. Prognostic Value of Optic Nerve Sheath Diameters after Acute Ischemic Stroke According to Slice Thickness on Computed Tomography. Diagnostics (Basel) 2024; 14:1754. [PMID: 39202242 PMCID: PMC11354098 DOI: 10.3390/diagnostics14161754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/06/2024] [Accepted: 08/10/2024] [Indexed: 09/03/2024] Open
Abstract
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.
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Affiliation(s)
- Han-Bin Lee
- Department of Neurology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Sang Hoon Oh
- Department of Emergency Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jinhee Jang
- Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Jaseong Koo
- Department of Neurology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hyo Jin Bang
- Department of Emergency Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Min Hwan Lee
- Department of Neurology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Netteland DF, Aarhus M, Sandset EC, Padayachy L, Helseth E, Brekken R. In Reply: Noninvasive Assessment of Intracranial Pressure: Deformability Index as an Adjunct to Optic Nerve Sheath Diameter to Increase Diagnostic Ability. Neurocrit Care 2024; 41:307-309. [PMID: 38951443 DOI: 10.1007/s12028-024-02027-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 05/23/2024] [Indexed: 07/03/2024]
Affiliation(s)
- Dag Ferner Netteland
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Mads Aarhus
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Else Charlotte Sandset
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- The Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Llewellyn Padayachy
- Department of Neurosurgery, School of Medicine, Faculty of Health Sciences, University of Pretoria, Steve Biko Academic Hospital, Pretoria, South Africa
| | - Eirik Helseth
- Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Reidar Brekken
- Department of Health Research, Medical Technology, SINTEF, Trondheim, Norway
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Vagal VS, Aziz YN, Gusler MT, Patel NM, Sekar P, Behymer TP, Woo D. Optic Nerve Sheath Diameter is not a predictor of functional outcomes in ICH Patients. J Stroke Cerebrovasc Dis 2024; 33:107831. [PMID: 38914358 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 06/17/2024] [Accepted: 06/20/2024] [Indexed: 06/26/2024] Open
Abstract
OBJECTIVES Optic nerve sheath diameter (ONSD) may serve as an early marker of increasing intracranial pressure resulting from intracerebral hemorrhage (ICH). We investigated if changes in ONSD can predict 90-day functional outcomes in ICH patients. MATERIALS AND METHODS We utilized ERICH (Ethnic/Racial Variations of Intracerebral Hemorrhage), a prospective, multi-center, case-control study of 3000 patients. We included patients with baseline and follow-up head CT with available outcomes. We measured change in ONSD from baseline and follow-up CT within a 6 (±1) hour window. Our primary outcome was the 90-day Modified Rankin (mRS) score. We compared patients with good (mRS 0-3) versus poor outcomes (mRS 4-6) to presence of significant change in ONSD using univariate analysis. We did an analysis of variance to assess for differences in ONSD. RESULTS Of 93 ICH patients who fit the inclusion criteria, the mean age was 64.1 (SD +/- 14.6), with 36.6 % being females. Forty-nine patients (47.1 %) had significant ONSD change between baseline and follow-up CT. ONSD change in the poor outcome group was not significantly different than that of the good outcome group in both the right and left hemispheres (p = 0.21 and p = 0.63 respectively). CONCLUSIONS We found that early change in the ONSD within the first 6 h of presentation in patients with ICH does not predict functional outcomes at three months.
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Affiliation(s)
| | | | | | - Nidhi M Patel
- Stony Brook University Renaissance School of Medicine
| | | | | | - Daniel Woo
- University of Cincinnati College of Medicine
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Kim KH, Kang HK, Koo HW. Prediction of Intracranial Pressure in Patients with an Aneurysmal Subarachnoid Hemorrhage Using Optic Nerve Sheath Diameter via Explainable Predictive Modeling. J Clin Med 2024; 13:2107. [PMID: 38610872 PMCID: PMC11012720 DOI: 10.3390/jcm13072107] [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: 02/22/2024] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
Background: The objective of this investigation was to formulate a model for predicting intracranial pressure (ICP) by utilizing optic nerve sheath diameter (ONSD) during endovascular treatment for an aneurysmal subarachnoid hemorrhage (aSAH), incorporating explainable predictive modeling. Methods: ONSD measurements were conducted using a handheld ultrasonography device during the course of endovascular treatment (n = 126, mean age 58.82 ± 14.86 years, and female ratio 67.46%). The optimal ONSD threshold associated with an increased ICP was determined. Additionally, the association between ONSD and ICP was validated through the application of a linear regression machine learning model. The correlation between ICP and various factors was explored through the modeling. Results: With an ICP threshold set at 20 cmH2O, 82 patients manifested an increased ICP, with a corresponding ONSD of 0.545 ± 0.08 cm. Similarly, with an ICP threshold set at 25 cmH2O, 44 patients demonstrated an increased ICP, with a cutoff ONSD of 0.553 cm. Conclusions: We revealed a robust correlation between ICP and ONSD. ONSD exhibited a significant association and demonstrated potential as a predictor of ICP in patients with an ICP ≥ 25 cmH2O. The findings suggest its potential as a valuable index in clinical practice, proposing a reference value of ONSD for increased ICP in the institution.
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Affiliation(s)
- Kwang Hyeon Kim
- Clinical Research Support Center, Inje University Ilsan Paik Hospital, Goyang 10380, Republic of Korea
| | - Hyung Koo Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang 10380, Republic of Korea
| | - Hae-Won Koo
- Department of Neurosurgery, College of Medicine, Inje University Ilsan Paik Hospital, Goyang 10380, Republic of Korea
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Kim J, Shin H, Lee H. Association between optic nerve sheath diameter/eyeball transverse diameter ratio and neurological outcomes in patients with aneurysmal subarachnoid hemorrhage. J Korean Neurosurg Soc 2023; 66:664-671. [PMID: 37253599 PMCID: PMC10641421 DOI: 10.3340/jkns.2023.0073] [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] [Revised: 05/09/2023] [Accepted: 05/25/2023] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE The optic nerve sheath diameter (ONSD)/eyeball transverse diameter (ETD) ratio is a more reliable marker of intracranial pressure than the ONSD alone. We aimed to investigate the predictive value of the ONSD/ETD ratio (OER) for neurological outcomes in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS Adult patients with aSAH who visited the emergency department of a tertiary hospital connected to a South Korean university between January 2015 and December 2021 were included. Data on patient characteristics and brain computed tomography scan findings, including the ONSD and ETD, were collected using a predefined protocol. According to the neurological outcome at hospital discharge, the patients were divided into the unfavorable neurological outcome (UNO; cerebral performance category [CPC] score 3-5) and the favorable neurological outcome (FNO; CPC score 1-2) groups. The primary outcome was the association between the OER and neurological outcomes in patients with aSAH. RESULTS A total of 171 patients were included in the study, of whom 118 patients (69%) had UNO. Neither the ONSD (p=0.075) nor ETD (p=0.403) showed significant differences between the two groups. However, the OER was significantly higher in the UNO group in the univariate analysis (p=0.045). The area under the receiver operating characteristic curve of the OER for predicting UNO was 0.603 (p=0.031). There was no independent relationship between the OER and UNO in the multivariate logistic regression analysis (adjusted odds ratio, 0.010; p=0.576). CONCLUSION The OER was significantly higher in patients with UNO than in those with FNO, and the OER was more reliable than the ONSD alone. However, the OER had limited utility in predicting UNO in patients with aSAH.
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Affiliation(s)
- Jinsung Kim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Hyungoo Shin
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Heekyung Lee
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
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Miao Q, Yan Y, Zhou M, Sun X. The Role of Nursing Care in the Management of Patients with Traumatic Subarachnoid Hemorrhage. Galen Med J 2023; 12:1-11. [PMID: 38774855 PMCID: PMC11108670 DOI: 10.31661/gmj.v12i0.3013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Indexed: 05/24/2024] Open
Abstract
Traumatic subarachnoid hemorrhage (tSAH) is a critical condition that requires comprehensive management to optimize patient outcomes. Nursing care plays a key role in the overall management of patients with tSAH via various aspects of care, including neurological assessment, monitoring, intervention, and education. In this review, we aim to evaluate the significant contributions of nursing care in managing patients with tSAH. Nurses perform initial neurological assessments, including the glasgow coma scale, pupil reactivity, vital signs, and sensory-motor evaluations. These assessments provide valuable information for early identification of deteriorating neurological status and prompt intervention. Additionally, nurses closely monitor intracranial pressure (ICP), cerebral perfusion pressure, and other hemodynamic parameters, assisting in the prevention and timely detection of secondary brain injury. For example, some strategies to manage ICP include elevating the head of the bed, maintaining adequate oxygenation and ventilation, administering proper medications, and ensuring fluid and electrolyte balance. Also, through careful monitoring, early recognition, and appropriate preventive measures, nursing care could prevent complications, including infections, deep vein thrombosis, and pressure ulcers. Furthermore, nursing care extends beyond physical management and encompasses psychosocial support for patients and their families. Nurses establish therapeutic relationships, providing emotional support, education, and counseling to alleviate anxiety, address concerns, and facilitate coping mechanisms. Education regarding medication management, lifestyle modifications, and the importance of regular follow-up enhances patient compliance and promotes long-term recovery.
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Affiliation(s)
- Qun Miao
- Department of Neurosurgery, Funan County People’s Hospital, Fuyang, Anhui 236300,
China
| | - Yan Yan
- Department of Neurosurgery, Funan County People’s Hospital, Fuyang, Anhui 236300,
China
| | - Mengjie Zhou
- Department of Neurosurgery, Funan County People’s Hospital, Fuyang, Anhui 236300,
China
| | - Xueqi Sun
- Department of Neurosurgery, Funan County People’s Hospital, Fuyang, Anhui 236300,
China
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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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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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Xu H, Li Y, Liu J, Chen Z, Chen Q, Xiang Y, Zhang M, He W, Zhuang Y, Yang Y, Chen W, Chen Y. Dilated Optic Nerve Sheath Diameter Predicts Poor Outcome in Acute Spontaneous Intracerebral Hemorrhage. Cerebrovasc Dis 2021; 51:199-206. [PMID: 34569518 DOI: 10.1159/000518724] [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: 03/29/2021] [Accepted: 07/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Optic nerve sheath diameter (ONSD) enlargement occurs in patients with intracerebral hemorrhage (ICH). However, the relationship between ONSD and prognosis of ICH is uncertain. This study aimed to investigate the predictive value of ONSD on poor outcome of patients with acute spontaneous ICH. METHODS We studied 529 consecutive patients with acute spontaneous ICH who underwent initial CT within 6 h of symptom onset between October 2016 and February 2019. The ONSDs were measured 3 mm behind the eyeball on initial CT images. Poor outcome was defined as having a Glasgow Outcome Scale (GOS) score of 1-3, and favorable outcome was defined as having a GOS score of 4-5 at discharge. RESULTS The ONSD of the poor outcome group was significantly greater than that of the favorable outcome group (5.87 ± 0.86 vs. 5.21 ± 0.69 mm, p < 0.001). ONSD was related to hematoma volume (r = 0.475, p < 0.001). Adjusting other meaningful predictors, ONSD (OR: 2.83; 95% CI: 1.94-4.15) was associated with poor functional outcome by multivariable logistic regression analysis. Receiver operating characteristic curve showed that the ONSD improved the accuracy of ultraearly hematoma growth in the prediction of poor outcome (AUC: 0.790 vs. 0.755, p = 0.016). The multivariable logistic regression model with all the meaningful predictors showed a better predictive performance than the model without ONSD (AUC: 0.862 vs. 0.831, p = 0.001). CONCLUSIONS The dilated ONSD measured on initial CT indicated elevated intracranial pressure and poor outcome, so appropriate intervention should be taken in time.
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Affiliation(s)
- Haoli Xu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuting Li
- Zhejiang University School of Medicine, Hangzhou, China
| | - Jinjin Liu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhonggang Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qian Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yilan Xiang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Mingyue Zhang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wenwen He
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yuandi Zhuang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weijian Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Cenik Y, Baydin A, Çakmak E, Fidan M, Aydin K, Tuncel ÖK, Aslan K. The Effect of Biomarkers and Optic Nerve Sheath Diameter in Determining Mortality in non-Traumatic Subarachnoid Hemorrhage. Clin Neurol Neurosurg 2021; 207:106813. [PMID: 34311386 DOI: 10.1016/j.clineuro.2021.106813] [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] [Received: 04/13/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
Abstract
AIM Although radiological methods are sufficient for the diagnosis of spontaneous subarachnoid hemorrhage (SAH), additional biomarkers are needed to predict prognosis. The aim of this study was to investigate the effects of serum S100B protein, Glial Fibrillary Acidic Protein (GFAP) levels and, Optic Nerve Sheath Diameter (ONSD) on mortality and clinical severity in patients with spontaneous SAH. MATERIALS AND METHODS Fifty-six patients who were diagnosed with SAH after first evaluation in the emergency department (ED) were included in the study group; Forty-six patients who were admitted to the ED with headache of non-intracranial etiology, were included as the control group. Cerebral computed tomography (CT) images and peripheral blood samples were obtained from all patients; at the time of diagnosis and 24 h after diagnosis. Serum S100B protein and GFAP levels were measured from the blood samples and ONSD was measured on CT. RESULTS Serum S100B protein and GFAP levels and, ONSDs at the time of diagnosis and 24 h after diagnosis were significantly higher in the study group (p < 0.05). Both GFAP levels and ONSD at the time of diagnosis and 24 h after the diagnosis were found to be related with increased mortality (p < 0.05). A similar association was found for serum S100B protein levels 24 h after the diagnosis, but not at the time of diagnosis (p = 0.540). CONCLUSION Serum S100B protein and GFAP levels and, ONSD were increased in patients with spontaneous SAH. All parameters were found to be associated with increased mortality.
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Affiliation(s)
- Yavuz Cenik
- Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Ahmet Baydin
- Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey.
| | - Eser Çakmak
- Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Murat Fidan
- Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Keramettin Aydin
- Department of Neurosurgery, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Özgür Korhan Tuncel
- Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey
| | - Kerim Aslan
- Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, 55139 Samsun, Turkey
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Zhu S, Cheng C, Zhao D, Zhao Y, Liu X, Zhang J. The clinical and prognostic values of optic nerve sheath diameter and optic nerve sheath diameter/eyeball transverse diameter ratio in comatose patients with supratentorial lesions. BMC Neurol 2021; 21:259. [PMID: 34215217 PMCID: PMC8252315 DOI: 10.1186/s12883-021-02285-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background The optic nerve sheath diameter (ONSD) and ONSD/eyeball transverse diameter (ETD) ratio have been proven to be correlated with intracranial pressure. This study aimed to evaluate the prognostic roles of ONSD and the ONSD/ETD ratio in comatose patients with supratentorial lesions and to determine the relationship of these two indices with the prognosis of such patients. Methods A total of 54 comatose patients with supratentorial lesions and 50 healthy controls were retrospectively included in this study. ONSD and ETD were measured by unenhanced computed tomography (CT). The differences in ONSD and the ONSD/ETD ratio between the two groups were compared. The prognosis of comatose patients was scored using the Glasgow Outcome Scale (GOS) at the 3-month follow-up, and these patients were classified into good (GOS score ≥ 3) and poor (GOS score < 3) prognosis groups. The differences in ONSD and the ONSD/ETD ratio were compared between comatose patients with good prognoses and those with poor prognoses. Results The ONSD and ONSD/ETD ratios in the comatose patients were 6.30 ± 0.60 mm and 0.27 ± 0.03, respectively, and both were significantly greater than those in the healthy controls (5.10 ± 0.47 mm, t = 11.426, P < 0.0001; 0.22 ± 0.02, t = 11.468, P < 0.0001; respectively). ONSD in patients with poor prognosis was significantly greater than that in patients with good prognosis (6.40 ± 0.56 vs. 6.03 ± 0.61 mm, t = 2.197, P = 0.032). The ONSD/ETD ratio in patients with poor prognosis was significantly greater than that in patients with good prognosis (0.28 ± 0.02 vs. 0.26 ± 0.03, t = 2.622, P = 0.011). The area under the receiver operating characteristic (ROC) curve, used to predict the prognosis of comatose patients, was 0.650 (95% confidence interval (CI): 0.486–0.815, P = 0.078) for ONSD and 0.711 (95% CI: 0.548–0.874, P = 0.014) for the ONSD/ETD ratio. Conclusions The ONSD and ONSD/ETD ratios were elevated in comatose patients. The ONSD/ETD ratio might be more valuable than ONSD in predicting the prognoses of comatose patients with supratentorial lesions.
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Affiliation(s)
- Sha Zhu
- Department of Neurology, Peking University People's Hospital, No. 11 South Avenue, Xi Zhi Men Xicheng District, Beijing, 100044, China
| | - Chao Cheng
- Department of Radiology, Peking University International Hospital, Beijing, China
| | - Dianjiang Zhao
- Department of Radiology, Peking University International Hospital, Beijing, China
| | - Yuanli Zhao
- Department of Neurosurgery, Peking University International Hospital, Beijing, China.,Department of Neurosurgery, Beijing TianTan Hospital, Beijing, China
| | - Xianzeng Liu
- Department of Neurology, Peking University International Hospital, No. 1 Life Science Park Life Road, Changping District, Beijing, 102206, China.
| | - Jun Zhang
- Department of Neurology, Peking University People's Hospital, No. 11 South Avenue, Xi Zhi Men Xicheng District, Beijing, 100044, China.
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Koo HW. Real-time change of optic nerve sheath diameter after rebleeding of ruptured intracranial dissecting aneurysm. J Cerebrovasc Endovasc Neurosurg 2021; 22:287-293. [PMID: 33472293 PMCID: PMC7820271 DOI: 10.7461/jcen.2020.e2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 12/17/2020] [Indexed: 11/23/2022] Open
Abstract
Ultrasonographic measurement of optic nerve sheath diameter (ONSD) has been validated to detect and monitor the increased intracranial pressure (IICP) in neurosurgical field. Especially, the ONSD has been known to reflect well the ICP in case of intracranial hemorrhage (ICH) occurring in the anterior circulation of intracranial vascular system, however it has not been well elucidated the role of ONSD in the posterior circulating vascular problems. A 43-year-old man presented with a subarachnoid hemorrhage with intraventricular hemorrhage due to rupture of dissecting aneurysm at right vertebral artery, and immediately performed the stent-assisted coil embolization. Two day after coil embolization, he became nearly alert without definite neurologic deficits. The ONSD was reduced from 5.8 mm to 5.5 mm. The 10th postoperative days, the patient suddenly changed into stuporous mentality due to rebleeding of aneurysm. The ONSD was enlarged to 6.7 mm. We report a case of intimate relationship between ONSD and IICP after rupture of dissecting aneurysm located in posterior circulation.
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Affiliation(s)
- Hae-Won Koo
- Department of Neurosurgery, Inje University, Ilsan Paik Hospital, Neuroscience, Radiosurgery and Adaptive Hybrid Neurosurgery Research Center, Goyang, Korea
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Abstract
Die Optikus-Sonografie bildet Papille, Sehnerv sowie dessen perineuralenLiquorraum ab und eröffnet damit u. a. einen diagnostischen Zugang zumintrakraniellen Liquorsystem und dessen Druck(ICP). Auf diese Weise lässt sich eine relevante ICP-Erhöhung über 20 mmHg nicht-invasiv und bettseitig belegen. Mit Einzelmessungen und Verlaufskontrollen hilft die Methode u. a. vor und nach der Etablierung eines invasiven ICP-Monitorings in der Intensiv- und Notfallmedizin sowie bei der Beurteilung chronischer Dysregulationen des ICP.
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Zoerle T, Stocchetti N. The Authors Reply: Is Optic Nerve Sheath Diameter a Reliable Proxy for Intracranial Pressure in Patients with Subarachnoid Hemorrhage? Neurocrit Care 2020; 33:621-622. [PMID: 32681414 DOI: 10.1007/s12028-020-01045-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Tommaso Zoerle
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Nino Stocchetti
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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15
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Is Optic Nerve Sheath Diameter a Reliable Proxy for Intracranial Pressure in Patients with Subarachnoid Hemorrhage? Neurocrit Care 2020; 33:617-618. [DOI: 10.1007/s12028-020-01038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Lee SJ, Choi MH, Lee SE, Park JH, Park B, Lee JS, Hong JM. Optic nerve sheath diameter change in prediction of malignant cerebral edema in ischemic stroke: an observational study. BMC Neurol 2020; 20:354. [PMID: 32962645 PMCID: PMC7510108 DOI: 10.1186/s12883-020-01931-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 09/14/2020] [Indexed: 12/28/2022] Open
Abstract
Background In acute large anterior circulation infarct patients with large core volume, we evaluated the role of optic nerve sheath diameter (ONSD) change rates in prediction of malignant progression. Methods We performed a retrospective observational study including patients with anterior circulation acute ischemic stroke with large ischemic cores from January 2010 to October 2017. Primary outcome was defined as undergoing decompressive surgery or death due to severe cerebral edema, and termed malignant progression. Patients were divided into malignant progressors and nonprogressors. Malignant progression was divided into early progression that occurred before D1 CT, and late progression that occurred afterwards. Retrospective analysis of changes in mean ONSD/eyeball transverse diameter (ETD) ratio, and midline shifting (MLS) were evaluated on serial computed tomography (CT). Through analysis of CT at baseline, postprocedure, and at D1, the predictive ability of time based change in ONSD/ETD ratio in predicting malignant progression was evaluated. Results A total of 58 patients were included. Nineteen (32.8%) were classified as malignant; 12 early, and 7 late progressions. In analysis of CTpostprocedure, A 1 mm/hr. rate of change in MLS during the CTbaseline-CTpostprocedure time phase lead to a 6.7 fold increased odds of early malignant progression (p < 0.05). For ONSD/ETD, 1%/hr. change lead to a 1.6 fold increased odds, but this association was trending (p = 0.249). In the CTD1, 1%/day change of ONSD/ETD in the CTbaseline-CTD1 time phase lead to a 1.4 fold increased odds of late malignant progression (p = 0.021) while 1 mm/day rate of change in MLS lead to a 1.5 fold increased odds (p = 0.014). Conclusions The rate of ONSD/ETD changes compared to baseline at D1 CT can be a predictor of late malignant progression along with MLS. ONSD/ETD change rates evaluated at postprocedure did not predict early malignant progression.
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Affiliation(s)
- Seong-Joon Lee
- Department of Neurology, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Mun Hee Choi
- Department of Neurology, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Sung Eun Lee
- Department of Neurology, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Ji Hyun Park
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea
| | - Bumhee Park
- Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea.,Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Soo Lee
- Department of Neurology, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea
| | - Ji Man Hong
- Department of Neurology, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea.
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Zoerle T, Caccioppola A, D'Angelo E, Carbonara M, Conte G, Avignone S, Zanier ER, Birg T, Ortolano F, Triulzi F, Stocchetti N. Optic Nerve Sheath Diameter is not Related to Intracranial Pressure in Subarachnoid Hemorrhage Patients. Neurocrit Care 2020; 33:491-498. [PMID: 32314244 DOI: 10.1007/s12028-020-00970-y] [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] [Indexed: 12/17/2022]
Abstract
BACKGROUND Intracranial pressure (ICP) monitoring is essential after subarachnoid hemorrhage (SAH) to prevent secondary brain insults and to tailor individualized treatments. Optic nerve sheath diameter (ONSD), measured using ultrasound (US), could serve as a noninvasive bedside tool to estimate ICP, avoiding the risks of hemorrhage or infection related to intracranial catheters. The aims of this study were twofold: first, to explore the reliability of US for measuring ONSD; second, to establish whether the US-ONSD can be considered a proxy for ICP in SAH patients early after bleeding. For the first aim, we compared the ONSD measurements given by magnetic resonance imaging (MRI-ONSD) with the US-ONSD findings. For the second aim, we analyzed the relationship between US-ONSD measurements and ICP values. METHODS Adult patients with diagnosis of aneurysmal SAH and external ventricular drainage system (EVD) were included. Ten patients were examined by MRI to assess ONSD, and the results were compared to the diameter given by US. In 20 patients, the US-ONSD values were related to ICP measured simultaneously through EVD. In ten of these patients, we explored the changes in the US-ONSD at the time of controlled and fairly rapid changes in ICP after cerebrospinal fluid (CSF) drainage. RESULTS US-ONSD measurements at the bedside were accurate, very similar to the diameters measured by MRI (the mean difference in the Bland-Altman plot was 0.08 mm, 95% limits of agreement: - 1.13; + 1.23 mm). No clear relationship was detectable between the ICP and US-ONSD, and a linear regression model showed an angular coefficient very close to 0 (p > 0.05). US-ONSD and ICP values were in agreement after CSF drainage and shifts in ICP in a limited number of patients. CONCLUSIONS US-ONSD measurement does not accurately estimate ICP in SAH patients in the intensive care unit.
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Affiliation(s)
- Tommaso Zoerle
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Alessio Caccioppola
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Eleonora D'Angelo
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Carbonara
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Conte
- Department of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sabrina Avignone
- Department of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa R Zanier
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Tatiana Birg
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabrizio Ortolano
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Triulzi
- Department of Neuroradiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Nino Stocchetti
- Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Lee S, Kim YO, Ryu JA. Clinical usefulness of early serial measurements of C-reactive protein as outcome predictors in patients with subarachnoid hemorrhage. BMC Neurol 2020; 20:112. [PMID: 32220241 PMCID: PMC7099821 DOI: 10.1186/s12883-020-01687-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/16/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the role of C-reactive protein (CRP) in predicting neurological outcomes of patients with subarachnoid hemorrhage (SAH). METHODS In this retrospective, observational study of adult patients with SAH treated between January 2012 and June 2017. Initial CRP levels collected within 24 h from the onset of SAH, the follow-up CRP levels were measured. The primary outcome was neurological status at six-month follow-up assessed with the Glasgow Outcome Scale (GOS, 1 to 5). RESULTS Among 156 patients with SAH, 145 (92.9%) survived until discharge. Of these survivors, 109 (69.9%) manifested favorable neurological outcomes (GOS of 4 or 5). Initial CRP levels on admission and maximal CRP levels within four days were significantly higher in the group with poor neurological outcome compared with those manifesting favorable neurological outcomes (P = 0.022, P < 0.001, respectively). However, the clearance of CRPs did not differ significantly between the two groups (P = 0.785). Analysis of the receiver operating characteristic curve for prediction of poor neurological outcome showed that the performance of the maximal CRP was significantly better compared with the initial CRP or the clearance of CRP (P = 0.007, P < 0.001, respectively). In this study, the effect of CRP on neurological outcomes differed according to surgical clipping. The maximal CRP levels within four days facilitate the prediction of neurological outcomes of SAH patients without surgical clipping (C-statistic: 0.856, 95% confidence interval [CI]: 0.767-0.921). However, they were poorly associated with neurological prognoses in SAH patients who underwent surgical clipping (C-statistic: 0.562, 95% CI: 0.399-0.716). Multivariable logistic regression analysis revealed that age (adjusted odds ratio [OR]: 1.10, 95% CI: 1.052-1.158), initial Glasgow Coma Scale (adjusted OR: 0.74, 95% CI: 0.647-0.837), and maximal CRP without surgical clipping (adjusted OR: 1.27, 95% CI: 1.066-1.516) were significantly associated with poor neurological outcomes in SAH patients. CONCLUSIONS Early serial measurements of CRP may be used to predict neurological outcomes of SAH patients. Furthermore, maximal CRP levels within four days post-SAH are significantly correlated with poor neurological outcomes.
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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
| | - 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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Palermo J, Bojanowski M, Langevin S, Denault AY. Point-of-care handheld ophthalmic ultrasound in the diagnosis and evaluation of raised intracranial pressure and Terson syndrome: a description of two cases. Can J Anaesth 2020; 67:353-359. [PMID: 31758491 DOI: 10.1007/s12630-019-01531-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/11/2019] [Accepted: 10/02/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Ultrasound (US) examination of the eye can be used to detect and monitor elevated intracranial pressure (ICP) and its consequences. Elevated ICP is transmitted to the contiguous optic nerve and its sheath (dura mater), thus underlying the development of papilledema and a widened sheath diameter. The US measurement of the optic nerve sheath diameter (ONSD) has previously been validated to diagnose and monitor raised ICP. The occurrence of vitreous hemorrhage in association with subarachnoid hemorrhage (SAH)-i.e., Terson syndrome-can also be easily diagnosed using ophthalmic US. Because of its relevance in anesthesia and critical care, we describe how to perform the technique illustrated by two cases. CASE PRESENTATIONS A 72-yr-old man with hydrocephalus secondary to a SAH developed raised ICP following the removal of an external ventricular drainage (EVD) system. Daily ONSD measurements using handheld US allowed us to diagnose and monitor the progression and resolution of the intracranial hypertension following the placement of a second EVD system. We also describe the steps used to obtain ONSD measurements during the ophthalmic US examination of a 53-yr-old woman who presented with a stage IV SAH with concomitant bilateral vitreous hemorrhages or Terson syndrome. CONCLUSION Ophthalmic US using a handheld device to measure and monitor ONSD at the bedside is useful in diagnosing and monitoring the progression of intracranial hypertension following EVD removal in a patient with hydrocephalus secondary to SAH. Ophthalmic US can also be used to identify concomitant vitreous hemorrhage that is associated with a worse prognosis.
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Affiliation(s)
- Jennifer Palermo
- Department of Anesthesiology, Université de Montréal, Montreal, QC, Canada
| | - Michel Bojanowski
- Department of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Stéphan Langevin
- Department of Anesthesiology and Division of Critical Care, Institut Universitaire de Cardiologie et de Pneumologie, Quebec, QC, Canada
| | - André Y Denault
- Division of Critical Care, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
- Department of Anesthesiology and Critical Care Division, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, 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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