Dilated Optic Nerve Sheath Diameter Predicts Poor Outcome in Acute Spontaneous Intracerebral Hemorrhage

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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POCUS OBTAINED OPTIC NERVE SHEATH DIAMETER IN PATIENTS PRESENTING WITH INTRACEREBRAL HEMORRHAGE

CHEST Journal ◽

10.1016/j.chest.2021.07.929 ◽

2021 ◽

Vol 160 (4) ◽

pp. A999

Author(s):

Alireza Nathani ◽

Braden Anderson ◽

Sarita Kambhampati ◽

Matthew Lohse ◽

Shekhar Ghamande

Keyword(s):

Optic Nerve ◽

Intracerebral Hemorrhage ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Nerve Sheath

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Abstract TP432: Dilated Optic Nerve Sheath Diameter by Trans-Orbital Ultrasound Predicts Mortality Among Patients With Acute Intracerebral Hemorrhage

Stroke ◽

10.1161/str.50.suppl_1.tp432 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Francisco A Dias ◽

Clara M Barreira ◽

Maria Clara Z Zontin ◽

Frederico F Alessio-Alves ◽

Rui K Martins ◽

...

Keyword(s):

Optic Nerve ◽

Intracerebral Hemorrhage ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Nerve Sheath ◽

Acute Intracerebral Hemorrhage

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Optic nerve sheath diameter sonography during the acute stage of intracerebral hemorrhage: a potential role in monitoring neurocritical patients

The Ultrasound Journal ◽

10.1186/s13089-020-00196-1 ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

M. Bender ◽

S. Lakicevic ◽

N. Pravdic ◽

S. Schreiber ◽

B. Malojcic

Keyword(s):

Optic Nerve ◽

Clinical Outcome ◽

Intracerebral Hemorrhage ◽

Ct Scan ◽

Healthy Volunteers ◽

Optic Nerve Sheath Diameter ◽

Acute Stage ◽

Optic Nerve Sheath ◽

Nerve Sheath ◽

Brain Ct Scan

Abstract Background Optic nerve sheath diameter (ONSD) sonography has been proposed as a reliable bedside tool for the detection of increased intracranial pressure (ICP). ONSD reacts almost simultaneously to oscillations in ICP. The aim of this study was to investigate the ONSD dynamics in the acute stage of intracerebral hemorrhage (ICH) and to compare ONSD dynamics to the clinical outcome. Methods We enrolled 35 acute ICH patients and 20 healthy volunteers in this prospective study. At the admission, all patients underwent brain CT scan and ONSD sonography. We repeated the ONSD on the second and the third day in all patients while CT scan was repeated if a patient condition deteriorated. The changes in serial ONSD measurements were termed as stable or unstable ONSD trend. ONSD trend was considered as unstable if variations of average ONSD were above 5%. The outcome of the patient was assessed with the Modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS). Results In healthy volunteers serial ONSD recordings for 3 days revealed a stable trend in 100%. However, in the study group, 23 patients had unstable and 12 had stable ONSD trend during the acute stage of ICH. The patients with unstable ONSD trend were more likely to have worse outcomes (p value 0.003). Conclusion In patients with ICH, the acute-phase ONSD dynamics can help in predicting the clinical outcome.

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Optic nerve sheath diameter on computed tomography not predictive of neurological status post-cardiac arrest

CJEM ◽

10.1017/cem.2016.348 ◽

2016 ◽

Vol 19 (3) ◽

pp. 181-185 ◽

Cited By ~ 6

Author(s):

Barret Rush ◽

Andrew Wormsbecker ◽

Landon Berger ◽

Katie Wiskar ◽

Mypinder S. Sekhon ◽

...

Keyword(s):

Computed Tomography ◽

Cardiac Arrest ◽

Optic Nerve ◽

Neurological Outcome ◽

Optic Nerve Sheath Diameter ◽

Optic Nerve Sheath ◽

Good Outcome ◽

Nerve Sheath ◽

Outcome Group ◽

Poor Neurological Outcome

AbstractObjectiveOptic nerve sheath diameter (ONSD) measured on a head computed tomography (CT) has been suggested as a potential prognostic factor for poor neurological outcome after cardiac arrest. We performed a single centre retrospective cohort analysis to further investigate this relationship.MethodsAll patients >18 years of age admitted to St. Paul’s Hospital in Vancouver, Canada who survived a cardiac arrest and had a CT scan of the head within 48 hours were included in the analysis.ResultsA total of 72 patients met inclusion criteria for the study; 54 (75.0%) of the patients had a poor neurological outcome, whereas 18 (25.0%) patients were discharged from the hospital with a good outcome. A CT head was obtained for patients in the good outcome group in a mean time of 9.3 hours (SD 10.0) compared to 10.2 hours (SD 11.2) for the poor outcome group (p=0.75). There was no difference in average ONSD observed between the two outcome groups (6.66 mm SD 0.78 v. 6.60 mm SD 0.82, p=0.77). Multiple logistic regression failed to show any association between ONSD and neurological outcome when adjusted for all other covariates (OR 1.32 95% CI 0.40-4.34, p=0.65). Setting an ONSD threshold of >8 mm (OR 2.32, 95% CI 0.14-39.40, p=0.55) or >7 mm (OR 0.28, 95% CI 0.03-2.77, p=0.28) also failed to show any association on neurological outcome.ConclusionThere was no observed difference in ONSD between those with a good neurological outcome and those with a poor outcome. ONSD was not an independent predictor of poor neurological outcome.

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