Optic nerve sheath diameter change in prediction of malignant cerebral edema in ischemic stroke: an observational study

Lee, Seong-Joon; Choi, Mihye; Lee, Sung Eun; Park, Ji Hyun; Park, Bumhee; Lee, Jin Soo

doi:10.1186/s12883-020-01931-w

Cited by 9 publications

(6 citation statements)

References 41 publications

(50 reference statements)

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“…Therefore, it can be inferred that ONSD / ETD may also be more valuable in predicting prognosis. Some researchers found that the changes in ONSD/ETD ratio compared to the baseline was predictive for late malignant progression in patients with malignant middle cerebral artery infarction [18].In cases with traumatic head injury without hemorrhage, there was an inverse correlation between ONSD/ETD ratio and the GOS [19].Our study found that ONSD/ ETD is more valuable in predicting the prognosis of comatose patients, which may be related to the small variability of ONSD / ETD. The prognostic value of ONSD / ETD needs to be further con rmed…”

Section: Discussionsupporting

confidence: 45%

Clinical Value of Optic Nerve Sheath Diameter Assessment in Prognosis of Comatose Patients with Supratentorial Lesions

Zhu

Cheng

Zhao

et al. 2021

Preprint

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Background and objectiveOptic nerve sheath diameter (ONSD) and ONSD/ eyeball transverse diameter (ETD) ratio have been proved to be related to intracranial pressure. This study aimed to evaluate ONSD and ONSD/ETD ratio in comatose patients with supratentorial lesions and determine the relationship of these two indexes with the prognosis of these patients.MethodsA total of 54 comatose patients with supratentorial lesion and 50 cases of normal controls were retrospectively included in this study. ONSD and ETD was messured on un-enhanced computed tomography(CT). The difference of ONSD, ONSD/ETD ratio between the two groups was compared. The prognosis of comatose patients were scored unsing Glasgow outcome scale (COS) at 3-month follow-up and classified into good (score ≥ 3) and poor (score < 3) prognosis. The differences of ONSD and ONSD/ETD ratio between good and poor prognosis of comatose patients were compared statistically.ResultONSD and ONSD / EDT in the comatose group were 6.30 ± 0.60 mm and 0.27 ± 0.03, respectively, both were significantly greater than that in normal 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 poor prognosis was siginificantly greater than that in good prognosis (6.40 ± 0.56 mm vs. 6.03 ± 0.61 mm, t = 2.197, P = 0.032). ONSD / EDT raito in poor grognosis was significantly higher than that in good gronosis (0.28 ± 0.02 vs 0.26 ± 0.03, t = 2.622, P = 0.011). The area under the responder operating charateristic curve to predict prognosis of comatose patients were 0.650 ( 95% CI: 0.486–0.815, P = 0.078) for ONSD and 0.711( 95% CI: 0.548–0.874, P = 0.014) for ONSD/ETD ratio, respectively.ConclusionsONSD and ONSD / EDT raito increased in comatose patients. ONSD / EDT raito may be more valuable than ONSD in evaluation for prognosis of comatose patients with Supratentorial lesions.

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Section: Discussionsupporting

confidence: 45%

Clinical Value of Optic Nerve Sheath Diameter Assessment in Prognosis of Comatose Patients with Supratentorial Lesions

Zhu

Cheng

Zhao

et al. 2021

Preprint

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“…The change in ONSD can be used safely to predict malignant cerebral oedema. Still, the increase in ONSD within the first 60 minutes may be identified as the measurements and changes made in this process are not very suitable for complication follow-up, even if the patients assigned rTPA do not occur complications due to rTPA [18].…”

Section: Discussionmentioning

confidence: 99%

The Prediction of the Increase in intracranial Pressure in Stroke Patients Given Recombinant Tissue Plasminogen Activator by Measuring the optic Nerve Sheath Diameter on bedside Ultrasound.

Hekimsoy¹,

Gölgeli²,

Çelik³

et al. 2023

AJTES

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Background: The aim of this study is based on the effects of the treatment, the recombinant tissue plasminogen activator (rTPA), applied to stroke patients in Emergency Departments (ED) by intravenous, to optic nerve sheath diameter (ONSD) measurements. Material and Methods: The study was designed as prospective and observational. A total of 41 patients were included in this study with the following diagnoses: an acute clinical stroke, known well-being within 4.5 hours, and who had a finding for rTPA. Ultrasonographic (USG) ONSD measurements have been performed on a voluntary basis with the consent of the patients and their relatives. Results: A statistically significant difference has been found between the ONSDs measured at the 0th, 15th, 30th and 60th minutes of the patients who were admitted to the ED and were on rTPA treatment due to stroke (p<0.05). Due to a large number of positive differences, the ONSD at the 15th, 30th, and 60th minutes was found higher than at the 0th minute. A statistically significant difference has also been found between ONSD measured at the 15th, 30th, and 60th minutes during rTPA treatment (p<0.05). Since the existence of a large number of positive differences, the ONSD at the 30th and 60th minutes is found to be higher than at the 15th minute. Finally, the difference of statistically significant values between the 30th and 60th-minute ONSD was determined by the Sign Test. According to the result of the Sign Test, a statistically significant difference was found to be between the ONSD differences of the 30th and 60th minutes of rTPA treatment (p<0.05). Conclusions: Serial ONSD measurements performed at the bedside during the early stage in order to follow up on the intracranial complications of stroke patients may be misleading for the follow-up of complications within the first 60 minutes, which is the most critical stage. In this stage, symptom monitoring should be used in combination with ONSD and the decision should be made for treatment continues, accordingly.

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“…Due to the strong correlation between ONSD and ETD ( 12 ), the ONSD/ETD ratio has been introduced as a surrogate metric of ONSD accounting for interindividual variability due to orbit size ( 13 , 21 ). Several researches have reported that changes in the ONSD/ETD ratio are more effective than ONSD in detecting increased ICP ( 13 , 14 , 22 , 23 ). Albert et al ( 24 ) found that an ONSD of more than 5.25 mm and an ONSD/ETD ratio of more than 0.232 on initial CT may identify MCA stroke patients at high risk of developing malignant MCA syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…Albert et al ( 24 ) found that an ONSD of more than 5.25 mm and an ONSD/ETD ratio of more than 0.232 on initial CT may identify MCA stroke patients at high risk of developing malignant MCA syndrome. Lee et al ( 22 ) similarly described that the rate of ONSD/ETD changes can predict late malignant progression and midline shifting. The ONSD/ETD ratio may even reliably predict intracranial hypertension in traumatic brain injury patients ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Optic nerve sheath diameter and optic nerve sheath diameter/eyeball transverse diameter ratio in prediction of malignant progression in ischemic stroke

et al. 2022

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BackgroundThe optic nerve sheath diameter (ONSD)/eyeball transverse diameter (ETD) ratio has been suggested in the evaluation of intracranial pressure (ICP). The aim of this study was to evaluate the predictive value of ONSD and ONSD/ETD in relation to risk for secondary malignant middle cerebral artery infarction (MMI).MethodsA total of 91 patients with MCA occlusion were included in this study. Data were divided into two groups based on development of MMI or not. ONSD and ETD were measured by unenhanced computed tomography (CT). The differences in ONSD and the ONSD/ETD ratios between the MMI and non-MMI groups were compared. Receiver operating characteristic curve analyses were used to test the diagnostic value of ONSD and ONSD/ETD independently, to predict MMI.ResultsThe ONSD in the MMI group and non-MMI group were 5.744 ± 0.140 mm and 5.443 ± 0.315 mm, respectively (P = 0.001). In addition, the ONSD/ETD ratios in the MMI group and non-MMI group were 0.258 ± 0.008 and 0.245 ± 0.006, respectively (P = 0.001). The receiver operating characteristic (ROC) curve demonstrated an area under the curve (AUC) for ONSD of 0.812 [95% confidence interval (CI): 0.718–0.906, P = 0.001], with a sensitivity of 97.4% and a specificity of 66.0% at the cut-off value of 5.520 mm. The AUC for ONSD/ETD ratio in predicting occurrence of MMI was 0.895 (95% CI: 0.823–0.968, P = 0.001), with a sensitivity of 84.2% and a specificity of 92.5% at a cut-off value of 0.250.ConclusionIn acute stroke patients with massive cerebral infarction, an increased ONSD or ONSD/ETD ratio increases the odds of malignant progression and may be used as an indicator for emergent therapeutic interventions. In addition, the ONSD/ETD ratio may be more valuable than ONSD in predicting the malignant progression of acute stroke patients.

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Optic nerve sheath diameter change in prediction of malignant cerebral edema in ischemic stroke: an observational study

Cited by 9 publications

References 41 publications

Clinical Value of Optic Nerve Sheath Diameter Assessment in Prognosis of Comatose Patients with Supratentorial Lesions

Clinical Value of Optic Nerve Sheath Diameter Assessment in Prognosis of Comatose Patients with Supratentorial Lesions

The Prediction of the Increase in intracranial Pressure in Stroke Patients Given Recombinant Tissue Plasminogen Activator by Measuring the optic Nerve Sheath Diameter on bedside Ultrasound.

Optic nerve sheath diameter and optic nerve sheath diameter/eyeball transverse diameter ratio in prediction of malignant progression in ischemic stroke

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