Estimate the severity of acute ischemic stroke by optic nerve sheath ultrasound.

The study aims to determine the correlation between diameter of optic nerve sheath on grey scale with increased intracranial pressure in patients with intracranial lesion. The research was conducted in Radiology Department of Dr. Wahidin Sudirohusodo Makassar from January 2019 – May 2019. The sample were 39 people aged ³18 years old with intracranial lesion. Axial computed tomography (CT) examination was performed to evaluate intracranial lesions and the presence of midline shift. The diameter of the optic nerve sheath was measured using eye ultrasonography. Data analyses used Spearman’s correlation test. The results showed that there was a correlation between the dilatation of the right and left optic nerve sheath diameter with midline shift (p value 0.04; p less than 0.05) on the diameter of the right optic nerve sheath showing a weak positive relationship (p value 0.02) for the diameter the optic nerve sheath left showing a medium positive relationship where the higher the midline shift, the wider the diameter of the left and right optical nerve sheath. There is a correlation between the right and left optic nerve sheath diameter (p less than equal 0.001) showing a strong positive relationship where the wider the diameter of the right optic nerve sheath, the wider the diameter of the left optic nerve sheath at high intracranial pressure. Statistically other results also obtained no relationship between dilatation of the diameter of the optic nerve sheath with clinical symptoms of increased intracranial pressure and type of lesion.

Optic nerve sheath diameter measured using magnetic resonance imaging and factors that influence results in healthy Chinese adults: a cross-sectional study.

Background and objectives: The optic nerve is a component of the central nervous system, and the optic nerve sheath is connected to the subarachnoid space. For this reason, intracranial pressure (ICP) increases are directly transmitted to the optic nerve sheath. Knowing the normal optic nerve sheath diameter (ONSD) range in a healthy population is necessary to interpret this measurement as a sign of intracranial pressure in clinical practice and research. In this study, we aimed to determine the standard ONSD value in healthy adultsaged65 years of age or older who had not previously been diagnosed with a disease that could increase the ICP. Materials and Methods: The right and left ONSD values and ONSD differences were compared, according to the gender of the patients. The patients were divided into 3 groups, according to their age. The age groups were assigned as follows: Group 1: 65–74 years of age; Group 2: 75–84 years of age; and Group 3: 85 years of age or older. The ONSDs and the ONSD difference between the left and right eyes of Group 1, Group 2 and Group 3 were compared. Results: The study included 195 volunteers. The mean ONSD of both eyes was 4.16±0.69 mm, and the difference between the ONSD of the left and right eyes was 0.16±0.18 mm. There was no difference between genders in terms of right ONSD, left ONSD, mean ONSD and ONSD difference between the left and right eyes. There was no correlation between age and ONSD and ONSD difference. When the age groups and ONSD were compared, no difference was found between the groups. Conclusions: In conclusion, the ONSDs of both eyes do not vary with age in healthy adults aged65 years or older. ONSD does not vary between genders. The calculation of ONSD difference can be used to determine ICP increase.

Objective: Timely detection of elevated intracranial pressure (ICP) in highrisk preterm infants may be critical to avoid permanent neurologic sequelae. Size of optic nerve sheath diameter (ONSD) is highly correlated with changes in ICP. Normal ultrasonographic ONSD values for preterm infants have been published. This study sought to compare these data with MRI measured OSND and to propose suggested ultrasonographic ONSD values. Methods: The ONSD in preterm MRIs were retrospectively measured and related to pre-existing ultrasonographic ONSD. Data were stratified for corrected gestational age. Simple linear regression between ONSD mean values and age was modeled for both eyes, and R² was calculated. Suggested values for ultrasonographic ONSD were ascertained through linear regression and calculated prediction intervals. Results: ONSD measurements demonstrated R² values of 0.95 (right ONSD MRI), 0.95 (left ONSD MRI), 0.96 (right ONSD ultrasound), and 0.93 (left ONSD ultrasound). Suggested ONSD values were incremental with corrected gestational age. Conclusion: ONSD measurements with MRI and ultrasound are similar. The proposed suggested ONSD values may be helpful in clinical situations where ICPs are suspected or known.

Optic nerve sheath diameter (ONSD) is a promising, noninvasive invasive intracranial pressure (ICP) measurement method. This study aims to analyze the differences in ONSD between the left and right eyeballs and the differences in ultrasonic measurement between the transverse and sagittal planes. Data from a total of 50 eligible patients with various types of brain injury who were admitted to our hospital from May 2019 to June 2021 were analyzed. An ONSD assessment was then performed using Philips B-mode ultrasound, measuring ONSD 3 mm posterior to the eyeballs. The left and right ONSDs in the transverse and sagittal planes were measured. Intraparenchymal fiber optic sensors and catheters were inserted into the ventricles and connected to an external pressure transducer to measure ICP. A total of 164 sonographic measurements of ONSD were performed in 50 patients with brain injury in a prospective observational study. Statistically significant differences were found in ONSD between the transverse and sagittal planes. The difference in the left ONSD between the transverse and sagittal planes was 0.007 ± 0.030 cm ( P = 0.003). The Spearman rank correlation test showed that the correlation coefficient between ICP and left/right ONSD in the transverse/sagittal planes was 0.495 vs 0.546 and 0.559 vs 0.605, respectively. The results showed that the areas under the curve of ONSD in the transverse and sagittal planes were 0.843 and 0.805, respectively. Medcalc software was used to compare the areas under the receiver operator characteristic curve, and the results showed that ONSD in the sagittal plane is generally better than in the transverse plane ( P = 0.0145). This study found that ONSD in the sagittal plane is superior to the transverse plane regarding the comprehensive efficacy of ICP, and unilateral measurement is sufficient.

Introduction: Though invasive intracranial devices are gold standard to calculate intracranial pressure (ICP); these are not without any complications. Non-invasive measurement of ICP by Ultrasonography could be a safe and portable technique.Objectives: The objective of the study was to measure and compare values of optic nerve sheath diameter of both eyes in healthy Nepalese adults.Methodology: A prospective cross-sectional study of healthy adult Nepalese volunteers was performed using a 7.5 MHz linear Ultrasound probe on the closed eyelids; optic nerve sheath diameter (ONSD) was measured 3 mm behind the globe in each eye.Results: Optic nerve sheath diameter (ONSD) of both eyes was measured in 100 healthy volunteers of age ranged from 15 to 75 years with a mean of 30.21 ± 14.05 years. There were 18 (18%) male and 82 (82%) female. ONSD for right eye ranged from 3.20 to 4.90 mm with mean of 4.10 ± 0.50 mm and left eye from 3.20 to 4.80 mm with mean of 4.22 ± 0.49 mm. P value for right and left eye ONSD (P = 0.06) and male and female (P = 0.12 and 0.85 for right and left ONSD respectively) were within normal limits. ONSD has no correlation with age (P = 0.27 and 0.27 for right and left ONSD respectively).Conclusion Mean of optic nerve sheath diameter (ONSD) is 4.10mm and 4.22 mm for right and left eye respectively. There is no statistical significant difference in mean of ONSD between right and left eye. BJHS 2018;3(1)5 : 357-360

Introduction: Peripheral arterial disease (PAD) had been shown to have a higher likelihood of developing cardiovascular events as well as cerebrovascular accidents particularly acute ischemic stroke. However, there are limited data on the association between ankle brachial index (ABI) values and the severity of ischemic stroke. This study aimed to determine the correlation of ABI values and the severity of acute ischemic stroke in Southern Philippines Medical Center. Methods: A prospective cross-sectional study with 112 patients diagnosed with acute ischemic stroke from June to October 2017. The ABI ratio of the subjects were obtained and correlated with the severity of stroke using National Institutes of Health Stroke Scale (NIHSS). Data analyses utilized chi-square test for categorical variables while ANOVA test for continuous variables. Spearman rho was used to determine the association between ABI and NIHSS. Results: Majority of patients with acute ischemic stroke had PAD with ABI ratio of ≤ 0.9 (51.8%). Using t-test, the NIHSS was significantly higher among patients with PAD having a mean score of 12.43 ± 5.29 compared to patients with normal ABI ratio having a mean score of 5.13 ± 4.09 (p= < 0.001). Furthermore, using Spearman’s rho statistics, ABI ratio was negatively correlated with NIHSS score (p < 0.001). Conclusion: Our results confirmed that there is a correlation between low ABI value and the severity of acute ischemic stroke. Routine ABI screening may help physicians intensify treatment strategies for those high-risk patients to prevent future events. Keywords: Peripheral arterial disease, ankle brachial index, stroke

To determine the distensibility and elastic characteristics of the optic nerve sheath for development of a basic understanding of ultrasound studies aimed to measure optic nerve sheath diameter (ONSD) for detection of acutely elevated intracranial pressure (ICP). Isolated human optic nerves preparations obtained from autopsies were submitted to predefined pressure alterations, and consecutive changes in ONSD were measured by B-scan ultrasound under defined conditions. Following submission to pressure, the diameter of the nerve sheath increased up to 140% of its baseline value. The increase (mean 1.97 mm, SD 0.52 mm) corresponded to the magnitude of pressure steps measured in the perineural subarachnoidal space (SAS). Similarly, the ONSD declined in each of the preparations within a few minutes after the optic nerve was decompressed. However, it did not reach its baseline value again when pressure loads of 45-55 mmHg or more had been applied. The elasticity of the anterior sheath of the optic nerve is sufficient for the detection of pressure changes in the SAS especially for upward pressure steps. This is basically important for the application of clinical monitoring of the sheath diameter to facilitate the identification of patients with elevated ICP non-invasively (screening). However, further implementation of this procedure in neurointensive care and emergency medicine has to consider that the sheath diameter reversibility may be impaired after episodes of prolonged intracranial hypertension and a model for hysteresis is proposed.

We assessed the correlation between optic nerve sheath diameter (ONSD) values measured by bedside ultrasound and intracranial pressure (ICP) changes among patients under neurocritical care and evaluated the diagnostic performance of ONSD for increased ICP. Sixty-seven neurologically critical patients who were hospitalised in the intensive care unit (ICU) of Jining No.1 People's Hospital between September 2023 and March 2024 and underwent lumbar puncture were included. The ONSD was measured and recorded using bedside ultrasound before the lumbar puncture. Patients were divided into normal and increased ICP groups on the basis of the initial lumbar puncture pressure on admission, and both groups were compared. Spearman's correlation analysis was used for evaluating the correlation between ONSD values and ICP. Receiver operating characteristic (ROC) curves were employed for evaluating the diagnostic performance of ONSD for increased ICP. At admission, the Glasgow Coma Scale scores of patients in the increased ICP group were significantly lower than those of patients in the normal ICP group (P < 0.05). The ONSD level of patients in the increased ICP group was significantly higher than that of patients in the normal ICP group (P < 0.05). Spearman's correlation analysis revealed that ONSD positively correlated with ICP among patients with severe neurological diseases (r = 0.777, P < 0.001). The area under the ROC curve when using ONSD for diagnosing lumbar puncture opening pressure ≥ 200 mmH2O was 0.896 (95% confidence interval, 0.817-0.974). When using ONSD ≥ 4.74mm as the threshold for diagnosing lumbar puncture opening pressure ≥ 200 mmH2O, the sensitivity and specificity were 0.909 and 0.765, respectively. In patients with critical neurological illness, ONSD measured using bedside ultrasound positively correlated with ICP. Increased ICP can be diagnosed for ONSD ≥ 4.74mm. The ONSD value measured by bedside ultrasound can be used for evaluating ICP among patients with critical neurological illness.

Purpose: Subconcussive head impacts (SHI) are known to cause a variety of negative sequelae including increased plasma concentrations of neuronal structural and glial proteins, attenuated neurovascular coupling, and impaired vestibular function. Traumatic brain injuries are associated with an increase in intracranial pressure (ICP). However, it is unknown whether an acute bout of SHI increases ICP. We tested the hypothesis that estimates of ICP via ultrasound assessments of optic nerve sheath diameter (ONSD) would be greater following a single session of repetitive SHI versus a control condition. Methods: 14 healthy participants (age: 19±2 y; BMI: 21±4 kg/m2, 3 women) with at least 3 y of soccer heading experience completed two experimental conditions in a randomized crossover design. 20 soccer headings were used to induce repetitive SHI and 20 soccer kicks were used as the control condition. A soccer ball was projected from a soccer JUGS machine (40 km/h, 12.2 m away) every 30 s for both conditions. ONSD assessed via ultrasound is associated with direct measures of ICP. Subjects were in the supine position during ONSD (transverse plane, each eye; B-mode linear array ultrasound), heart rate (HR; 3-lead ECG), and mean arterial blood pressure (MAP; photoplethysmography) measurements conducted at baseline prior to heading/kicking and at 2 h, 24 h, and 72 h post. ONSDs were measured 3 mm under the bulb in triplicate for each eye and the mean values were used for analyses. Inter-eye ONSD values were also averaged for analyses. Clinical intervention to alleviate elevated ICP is indicated when ONSD is &gt; 5.0 mm. Data were analyzed using a mixed-effects model with repeated measures with time and condition as within subject factors. Data are presented as mean ± SD if statistically significant. Results: No subjects had an ONSD &gt; 5.0 mm in either eye following heading or kicking. Left ONSD was greater than baseline at 2 h post heading (2.89 ± 0.25 mm vs. 2.99 ± 0.27 mm; p = 0.0157) and greater than baseline at 2 h (2.92 ± 0.37 mm vs. 2.98 ± 0.31 mm; p = 0.0352) and 72 h (3.08 ± 0.26 mm; p = 0.0067) post kicking. Left ONSD at 72 h post kicking was greater than heading (3.08 ± 0.26 mm vs. 2.93 ± 0.25 mm; p = 0.0022). There were no interaction effects for right ONSD (p = 0.4686), average ONSD (p = 0.1178), HR (p = 0.1039) or MAP (p = 0.3889). Conclusion: Neither the heading nor kicking intervention elicited a clinically relevant ONSD that would require medical attention. Contrary to our hypothesis, an acute bout of 20 soccer headers did not evoke greater ONSD in healthy subjects versus kicking. Therefore, our data indicate that a single session of SHI does not increase ICP. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Intracranial pressure increases due to ischemic infarction caused by stroke. This study aimed to evaluate the pre-thrombolytic and post-thrombolytic optic nerve sheath diameter (ONSD) measurements in predicting clinical outcomes and complications for stroke patients. ONSD was measured on computed tomography (CT) scans. The average ONSD (aONSD) was calculated from the right and left eyes. Pre-thrombolytic (ONSD-0) and post-thrombolytic (ONSD-24) values were compared according to right vs left eye, stroke-affected side of the brain, presence of complications, and mortality. Ninety-three patients were enrolled; 52.7% were female, and the mean age of all participants was 76 years. The aONSD-24 values were higher than the aONSD-0 values (5.5 ± 0.7 mm and 5.3 ± 0.7 mm, respectively, p < 0.001). There was no significant difference between right and left measurements (right ONSD-0 5.3 mm vs. left ONSD-0 5.3 mm, p = 0.257; right ONSD-24 5.6 mm vs. left ONSD-24 5.5 mm, p = 0.146; and ∆right ONSD 0.23 mm vs. ∆left ONSD 0.22, p = 0.717) and between the stroke-affected side and non-stroke-affected side measurements (stroke-affected ONSD-0 5.2 mm vs. non-stroke-affected ONSD-0 5.2 mm, p = 0.292; stroke-affected ONSD-24 5.5 mm vs. non-stroke-affected ONSD-24 5.4 mm, p = 0.124; and ∆stroke-affected ONSD 0.23 mm vs. non-∆stroke-affected ONSD 0.23 mm, p = 0.569). Intracranial complications occurred in 14 (15%) patients. There was no difference in ONSD values between patients with and without complications (p = 0.338 for aONSD-0, p = 0.216 for aONSD-24, and p = 0.902 for ∆a ONSD). There was no significant difference between the aONSD-0 and aONSD-24 values of surviving and non-surviving patients (aONSD-0: 5.3 ± 0.7 vs. 5.0 ± 0.5, p = 0.345; aONSD-24: 5.5 ± 0.7 vs. 5.3 ± 0.4, p = 0.522; and p = 0.386 for ∆ aONSD). ONSD values on 24-h brain CT scans were higher than admission values in acute stroke patients receiving thrombolytic therapy, irrespective of the right or left side, stroke-affected side, presence of complications, and mortality. However, ONSD is not a sufficient parameter for predicting complications and death.

There is little documentation describing the correlation between plasma adiponectin and the severity of ischemic stroke in the Indian population. The present study was aimed to find the correlation between plasma adiponectin levels and severity of acute ischemic stroke using the National Institute of Health Stroke Scale (NIHSS) and Modified Rankins Scale (MRS). The present prospective observational study was conducted on 109 patients of confirmed acute ischemic stroke aged ≥ 30 years presenting within 24 hours of new onset of neurodeficits. NIHSS and MRS were measured within 24 hours and 5 days after onset of symptoms respectively. Plasma adiponectin levels were measured. The primary objectives were to find the correlation of plasma adiponectin levels with severity of acute ischemic stroke using the NIHSS and neurological functional outcome using the MRS. The secondary objectives were to find an association of plasma adiponectin levels with serum lipid profile and comorbidities.There was a negative correlation between plasma adiponectin levels and NIHSS score (r = - 0.110, p-value = 0.253) and MRS (r = -0.041, p-value = 0.672) which was not statistically significant. The median plasma adiponectin levels were comparable between the groups of cases with co-morbidity and without co-morbidity. A significantly higher percentage of patients who had high triglyceride levels had normal plasma adiponectin levels. The distribution of other lipid parameters and hypertension did not differ significantly between the groups of cases with normal and abnormal plasma adiponectin levels. There was no correlation between plasma adiponectin levels and severity of acute ischemic stroke.

Transcranial ultrasonographic evaluation of effect of ventriculoperitoneal shunt on intracranial dynamics: A prospective observational study

Funding Acknowledgements Type of funding sources: None. Introduction A negative effect on the prognosis of ischemic stroke of the aggressive decrease in blood pressure, leading to a decrease in cerebral blood flow, is known. On the other side, increased blood pressure can be a compensatory mechanism. Currently, however, it is difficult to assess the adequacy of cerebral blood flow, one of the indicators of which is the blood flow velocity in the common carotid artery. Purpose The aim of this study was to estimate the peak systolic velocity in the common carotid arteries (CCA PSV) depending on the severity of acute ischemic stroke (IS). Methods 180 patients with acute ischemic stroke (70 females and 110 males, mean age was 66.3 ± 12.3 years) were studied. Including 46 (25.6%) patients with cardioembolic stroke, 25 (13.9%) - with a thrombotic stroke, 27 (15.0%) – with a lacunar stroke and 82 (45.5%) – with undifferentiated stroke. Most of them 173 (96.1%) had grade 3 of arterial hypertension according to ESH/ESC Guidelines for the management of arterial hypertension, 2018. 59 (32.8%) patients had coronary artery disease, 52 (28.9%) - had atrial fibrillation. Patients were categorized according to National Institutes of Health Stroke Scale (NIHSS) severity in mild NIHSS (&amp;lt;9) - 122 (67.8%) patients, moderate NIHSS (9–15) - 35 (19.4%) patients, and severe stroke NIHSS (&amp;gt;16) - 23 (12.8%) patients. Median NIHSS score was 9.2 ± 0.9. All patients underwent a transthoracic echocardiography and a carotid ultrasound examination. A comparative assessment of echographic parameters was performed in patients of lower (NIHSS score ≤ 4.0) and upper (NIHSS score≥11.0) quartile according to the NIHSS score. Results It is shown a decrease of peak systolic velocity in the common carotid arteries with an increase in the severity of IS on the NIHSS scale: in mild stroke, it was 73.9 ± 18.7 cm/s, in moderate stroke - 66.3 ± 19.2 cm/s (p = 0.04), in severe stroke - 62.1 ± 17,4 cm/sec (p = 0.006 and p = 0.4, respectively). Peak systolic velocity in patients with the lower quartile of stroke severity was 73.8 ± 19.1 cm/sec, in the group of patients with the upper quartile – 64.3 ± 19.2 cm/sec (р=0.02). There were no differences in the resistance index of common carotid arteries: 0.75 ± 0.05, 0.76 ± 0.06 and 0.75 ± 0.07 for mild, moderate and severe severity, respectively, p &amp;gt; 0.5). A multiple linear regression analysis in which the severity of ischemic stroke on the NIHSS scale was a dependent variable and age, CCA PSV, common carotid artery intima–media thickness and systolic, diastolic and pulse blood pressure were independent variables, showed that the severity of ischemic stroke was independently correlated with the CCA PSV (β =-0.13, p = 0.009). Conclusions.1. It is shown the decrease of peak systolic velocity in the common carotid arteries with an increase in the severity of ischemic stroke on the NIHSS scale. 2. The reduction of CCA PSV exacerbates brain ischemia and reflecting disorders of autoregulation of cerebral blood flow.

Introduction: Headache is one of the most important complaints in emergency room (ER) admissions, and the rate of the increase in intracranial pressure in these cases should not be overlooked. This study was performed to investigate the value of the measurement of optic nerve sheath diameter (ONSD) by ocular ultrasound in ER patients with the complaint of headache and increase in intracranial pressure regarding this. Materials and Methods: A total of 100 patients who applied to the ER with the complaint of headache were included in this prospective study. Fifty patients with increased ONSD (≥5 mm) and 50 patients with normal ONSD (<5 mm) were obtained. ONSD measurements were performed with 7.5–10 MHz linear probe and closed‑eye technique. In addition to this, all patients underwent cranial computerized tomography (CT) examinations, and CT results were compared with the results of the ocular ultrasound. Results: The median right and left ONSD values were detected to be 4.3 mm (3.6–5.5 mm) and 4.4 mm (3.6–5.6 mm) in patients whose cranial CT results were within normal limits. However, the median right and left ONSD values were detected to be 5.5 mm (5.1–6.3 mm) and 5.5 mm (5.1–6.4 mm) in patients whose cranial CT examination results were abnormal. In all cases with abnormal CT findings, the right and the left ONSD measurements were significantly higher ( P < 0.001). Furthermore, ONSD value in the ipsilateral side with the lesion was significantly higher than the contralateral side ( P < 0.001). Conclusion: Bedside ocular ultrasound is a noninvasive and easily applicable method in ER for the detection and evaluation of intracranial hypertension with headache. Keywords: Headache, intracranial hypertension, ocular ultrasound, optic nerve sheath diameter