Evaluation of Optic Nerve Sheath Diameter for Prediction of the Development of Brain Death in Patients Admitted to the Intensive Care Unit with Intracranial Hemorrhage

Abstract

Intracranial hemorrhage results in an increase in intracranial pressure, which is considered to be the leading cause of brain death. Follow-up of these patients and early recognition of possible brain death are important for organ donation. It has been shown that increased intracranial pressure is proportional to the changes in optic nerve sheath diameter. The aim of this study was to investigate the usability of changes in optic nerve sheath diameter secondary to increased intracranial pressure as a precursor for identification of patients who will develop brain death. Patients admitted to the intensive care unit with intracranial hemorrhage and a Glasgow Coma Scale score of 7 or less were divided into 3 groups: brain death group (patients with brain death), hemorrhage group (patients who died due to hemorrhage), and survivor group (patients who were discharged from the intensive care unit). Optic nerve sheath diameter was measured by computed tomography taken at admission. The highest value for optic nerve sheath diameter was measured in the brain death group (P < .001). The cutoff point for optic nerve sheath diameter to predict the presence of brain death was determined as >6.62 mm. The area underthe curve for optic nerve diameter was 0.85 (sensitivity 66.20%, specificity 90%; P < .001). The results showed a 25.529- fold increased risk of brain death in measurements above this value. An optic nerve sheath diameter value of >6.62 mm measured on initial cranial computed tomography of patients admitted to the intensive care unit with a diagnosis of intracranial hemorrhage is indicative of an increased risk of brain death.