Higher Optic Nerve Sheath Diameter Research Articles

Optic nerve sheath diameter and severity of central nervous infection

Background Central nervous system (CNS) infection affects the brain, and can cause cerebral edema, increased intracranial pressure (ICP), cerebral herniation, and death. Measurement of the optic nerve sheath diameter (ONSD) by ultrasound is a new, non–invasive examination to predict ICP, with high sensitivity and specificity.Objective To analyze for a possible association between ONSD measured by ultrasonographic examination and severity of CNS infection.
 Methods This cross–sectional study was performed in the Pediatric Department of Hasan Sadikin Hospital, Bandung, West Java. Subjects were chosen by consecutive sampling. We measured ONSD, examined clinical manifestations, as well as performed a cerebrospinal fluid (CSF) study and imaging of CNS infection. Data analysis was done by paired T–test and one–way ANOVA, followed by Tukey test on significant variables.
 Results Subjects consisted of 32 children with CNS infection. The most common clinical symptoms were fever, decreased consciousness, and nuchal rigidity. Bivariate analysis revealed strong positive associations between ONSD and Glasgow Coma Scale (GCS), increased protein levels in CSF, and type of CNS infection.
 Conclusion Larger ONSD is significantly associated with lower GCS, increases CSF protein, and particular CNS infections. The ONSD is also associated with meningitis tuberculosis grade III, with a higher mean ONSD of both eyes compares to other CNS infections. Hence, the higher the ONSD, the more severe the degree of CNS infection.

Automated pupillometry and optic nerve sheath diameter ultrasound to define tuberculous meningitis disease severity and prognosis

BackgroundTuberculous meningitis (TBM) causes high mortality and morbidity, in part due to raised intracranial pressure (ICP). Automated pupillometry (NPi) and optic nerve sheath diameter (ONSD) are both low-cost, easy-to-use and non-invasive techniques that correlate with ICP and neurological status. However, it is uncertain how to apply these techniques in the management of TBM. MethodsWe conducted a pilot study enrolling 20 adults with TBM in the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam. Our objective was to investigate the relationships between baseline and serial measurements of NPi and ONSD and disease severity and outcome. Serial NPi and ONSD were performed for 30 days, at discharge, and at 3-months, with measurements correlated with clinical progression and outcomes. ResultsONSD and NPi measurements had an inverse relationship. Higher ONSD and lower NPi values were associated with lower Glasgow coma score. Baseline NPi was a strong predictor 3-month outcome (median NPi 4.55, interquartile range 4.35–4.65 for good outcomes versus 2.60, IQR 0.65–3.95 for poor outcomes, p = 0.002). Pupil inequality (NPi ≥0.7) was also strongly associated with poor 3-month outcomes (p = 0.006). Individual participants' serial NPi and ONSD were variable during initial treatment and correlated with clinical condition and outcome. ConclusionPupillometry and ONSD may be used to predict clinical deterioration and outcome from TBM. Future, larger studies are need explore the optimal timing of measurements and to define how they might be used to optimise treatments and improve outcomes from TBM.

Prognostic role of optic nerve sheath diameter in stroke in emergency department, A case control study.

Sonographic measurement of optic nerve sheath diameter (ONSD) can reflect intracranial pressure (ICP) indirectly and determine the neurology intensive care unit (NICU) requirement and mortality in acute ischemic stroke (AIS). To demonstrate the effectiveness of ONSD to determine mortality, morbidity, and NICU requirement on patients with the AIS. The sonographic ONSD measurements were performed on each patient with AIS, over 18 years old. All patients were categorized according to the Oxfordshire Community Stroke Project (OCSP) classification system. MRI images were examined for increased ICP, and the patients were categorized into two groups as increased ICP (i-ICP) and normal ICP. The ONSD results were evaluated in terms of classifications, outcomes, and prognosis of the patients. One hundred and five patients were included and 31 (35.2%) were in the i-ICP group. The median ONSDs were 5.26 mm in the i-ICP group and 4.62 mm in the normal ICP group (P < 0.001). The median ONSDs were 5.13 mm in the NICU group and 4.69 mm in the neurology ward (NW) group (P = 0.001). The total anterior circulation infarction (TACI) subgroup had higher ONSDs than the others (TACI: 5.27 mm; PACI: 4.73 mm; POCI: 4.77 mm; and LACI: 4.64 mm, P < 0.001). The NICU requirements were higher in the TACI subgroup. The median ONSD was 5.42 mm in the deceased group (survived: 4.77 mm, P < 0.001). ONSD may be favorable for predicting the increased ICP and the NICU requirement in OCSP subgroups. Moreover, ONSD can be used to foresee the mortality of AIS.

Abstract No.: ABS2271: A Comparative Study of Optic Nerve Sheath Diameter and Lung Ultrasound Score in Healthy and Preeclampsia Parturients.

Background & Aims:Complications of preeclampsia include cerebral and pulmonary oedema which strongly correlate with optic nerve sheath diameter (ONSD) and lung ultrasound score (LUSS) respectively. This study was conducted to compare ONSD and LUSS in healthy and preeclamptic parturients.Methods:In this prospective observational analytical study, healthy pregnant women and preeclamptic women, 35 each, age >18 years and gestational age >34 weeks up to 24 hours of delivery, were included. Approval from institutional ethical committee was obtained and trial registered with clinical trial registry of India. Ultrasound assessment for ONSD and LUSS (12 region lung technique) was performed. Severity of preeclampsia was noted. Data was analysed using appropriate statistical tests. ROC analysis was performed to obtain a cutoff value for both ONSD and LUSS to predict complications of preeclampsia. A p-value of <0.05 was considered significant.Results:Of the 35 preeclamptic women, 19 had severe preeclampsia. Severe preeclamptics had higher ONSD and LUSS than mild preeclamptics and healthy parturients (p-value < 0.001). No difference was observed in LUSS between mild preeclamptics and healthy parturients. Mean ONSD of >4.65mm and LUSS of >2 predicted preeclampsia complications with a sensitivity of 77.14% and 68.57%, specificity of 91.43% and 85.71% and AUC of 0.907 and 0.806 respectively.Conclusion:ONSD and LUSS assessment is an easy, bedside, noninvasive technique to assess complications, guide fluid therapy and monitor response to treatment in preeclamptic parturients. Thus, early intervention can help in reducing maternal/fetal morbidity and mortality

Evaluation of the biomechanical properties of the posterior eye using Shear Wave Elastography in patients with increased intracranial pressure.

This study aims to investigate the biomechanical properties of the posterior eye using the shear wave elastography (SWE) in increased intracranial pressure (ICP) patients and healthy subjects. This study enrolled 54 healthy subjects and 54 patients with increased ICP, including 29 patients with space-occupying lesions (SOLs) and 25 patients with intracranial haemorrhage (ICH). Optic nerve sheath diameter and the stiffness of the optic nerve head, peripapil-lary sclera and optic nerve were evaluated. Patients with increased ICP had a significantly higher optic nerve sheath diameter, Young's modulus of optic nerve head, and Young's modulus of peripapillary sclera than healthy subjects (p<0.01 for all). The optic nerve sheath diameter, Young's modulus of optic nerve head and Young's modulus of the peripapillary sclera were similar between the SOLs group and ICH group (p>0.05 for all). Young's modulus of the optic nerve in the ICH group was similar to the control group (p>0.05), whereas the SOLs group had higher Young's modulus of optic nerve comparing the control group (p<0.05). The stiffness of the optic nerve head and peripapillary sclera were higher in patients with increased ICP than healthy subjects, and the optic nerve stiffness of SOLs patients was the highest in all subjects. The SWE could provide a quantitative analysis of the posterior eye's biomechanical properties and help the clinic diagnose the degree of visual impairments.

Optic Nerve Sheath Diameter in Acute Liver Failure: A Prospective Cohort Study

Introduction: Acute liver failure (ALF) is a rare disease that may lead to cerebral edema and death. An increased optic nerve sheath diameter (ONSD) may reflect an early increase in intracranial pressure. We assessed the feasibility and safety of the ONSD measurement and its association with outcomes in patients with ALF. Methods: This was an open-label prospective cohort study including adult patients with ALF admitted to a liver-specialized intensive care unit (ICU) in an academic center between October 2018 and February 2020 (among 24): 20 as intention-to-treat and 17 as per-protocol analyses. The ONSD measurement (primary exposure) used an ultrasound transducer (3 determinations on each eye per patient). The primary outcome was hospital mortality. Results: Among the 20 patients, 11 (55.0%) were females and the mean age was 45 ± 16 years. On the day of ONSD measurement (median 32.4 h post-ICU admission; IQR 19.8–59.8): 8 patients (40.0%) were in a coma, the mean international normalized ratio (INR) was 3.3 ± 1.4, median bilirubin was 12.3 mg/dL (IQR 4.7–24.5), mean ammonia was 163 ± 101 µmol/L, and mean SOFA score was 11 ± 5. The mean bilateral ONSD was 5.6 ± 0.7 mm, with a very good correlation between right and left eyes (Pearson’s r = 0.90). Ten (50.0%) patients were transplanted and 13 (65.0%) patients survived the hospital stay (all with a 2-month extended Glasgow Outcome Scale of 8). The mean ONSD was significantly higher for hospital non-survivors than survivors both in the intention-to-treat (6.2 vs. 5.3 mm; p = 0.004) and per-protocol (6.2 vs. 5.2 mm; p = 0.004) analyses. No adverse effects from ONSD measurements were reported. Conclusions: In patients with ALF, a higher ONSD was associated with higher hospital mortality. ONSD measurement is feasible and safe and may have prognostic value.

Abstract 303: Optic Nerve Sheath Diameter Differences by Sex, Rhythm, and Neurological Outcome After Out-of-hospital Cardiac Arrest

Introduction: Neurologically guided resuscitation after out-of-hospital cardiac arrest (OHCA) to improve survival has been limited due to knowledge gaps in cerebral edema changes. Point-of-care ultrasound (POCUS) for the assessment of optic nerve sheath diameter (ONSD) is an established modality to characterize the extent of cerebral edema. We aimed to describe ONSD differences by sex, rhythm type, neurological outcome using cerebral performance category (CPC), and overall survival status. Methods: We studied adult OHCA treated at an urban academic ED with return of spontaneous circulation (ROSC) from May 2018 to May 2020. After ROSC, trained emergency physicians obtained bilateral ONSD measurements at 1, 6, 24, 48, and 72 hours, in the transverse, oblique, and sagittal planes for each eye. All the ONSD measurements were averaged for each time point and comparisons were made between each predictor’s categories. To compare the mean at each time point between groups, t-test or ANOVA was used. The trend comparison was done using generalized estimating equations. Statistical analysis was performed using SAS 9.4 under the significance level of 0.05. Results: Out of 62 eligible patients, 35 (56%) were male and 27 (44%) were female, 33 (59%) had a shockable rhythm and 23 (41%) had non-shockable rhythm. At 72 hr, 6 (10%) had a CPC of 1-2 and 57 (90%) had CPC of 3-5. Overall, there were 37 (61%) survivors and 24 (39%) non-survivors. There was a notable sex difference in the mean ONSD across all time points between males and females (p = 0.031), with males showing higher ONSD, and between shockable and non-shockable (p= 0.035), with the shockable group having relatively lower ONSD. There is a statistically significant difference of mean ONSD between CPC 1-2 and CPC 3-5 groups at 6hr, 48hr, and at 72hr, with higher means in the CPC 3-5 group. Across all times, the trend line was statistically significant between non-survivors and survivors (p= 0.015), with non-survivors having higher ONSD. Conclusion: Males, patients with non-shockable rhythm, CPC 3-5 at 72 hr, and non-survivors had higher ONSD. Understanding cerebral edema dynamics during resuscitation will allow for future work to potentially tailor interventions to individual patient cerebral injury patterns.

Point-of-Care Ultrasound Abnormalities in Late-Onset Severe Preeclampsia: Prevalence and Association With Serum Albumin and Brain Natriuretic Peptide

(Anesth Analg. 2019;128(6):1208–1216) Care providers frequently use point-of-care ultrasound (POCUS) on pregnant women diagnosed with preeclampsia to prevent serious afflictions such as cerebral complications or cardiorespiratory failure. Present-day ultrasound research has found a number of indicators for pulmonary interstitial syndrome (PIS) and a higher optic nerve sheath diameter (ONSD), the latter of which could indicate elevated intracranial pressure. As of now, irregular laboratory markers of oncotic pressure and cardiac dysfunction have inconclusive clinical applications; many experts posit that reduced serum albumin level is a contributor to excessive brain fluid and brain swelling. These investigators examined patients with preeclampsia to determine how PIS, ONSD, brain natriuretic peptide (BNP), and serum albumin level contribute to cardiac dysfunction. They also aimed to study the comparison of information acquired from a POCUS examination to information recorded with traditional clinical methods.

Abstract 334: Point-Of-Care Ultrasound in the Assessment of Optic Nerve Sheath Diameter After Out-Of-Hospital Cardiac Arrest

Introduction: Hypoxic-ischemic injury from cardiac arrest may cause cerebral edema, leading to increased intracranial pressure (ICP) and brain tissue damage. Optic nerve sheath diameter (ONSD) is associated with elevated ICP. Limited clinical studies have reported ONSD changes in the early post-resuscitation time frame. We sought to evaluate the utility of bedside ocular ultrasound measurements in the assessment of post-cardiac arrest brain injury. Methods: We studied adult out-of-hospital cardiac arrests treated at an urban academic ED and achieving return of spontaneous circulation (ROSC) between May 2018 to May 2019. We included witnessed and unwitnessed arrest as well as shockable and non-shockable rhythms. After ROSC, trained emergency physicians performed bedside ultrasonographic assessment of bilateral ONSD at 1, 6, 24, 48, and 72 hours using an ocular preset on a 15MHz linear probe. ONSD measurements at these time frames were compared between groups stratified by rhythm type and neurological outcome. Cerebral performance category (CPC) was measured at 72 hours and at discharge. Results: Out of 48 eligible patients, 15 were excluded from the study due to lack of consent or available ultrasound images. We included 33 patients, of which 11 were female and 22 were male, with a median age of 57 (IQR 20). There were 19 with an initial rhythm of asystole or pulseless electrical activity (PEA), 9 with ventricular fibrillation arrests, and 5 with an unclear rhythm. At 1 hour, patients with CPC 1-2 had smaller ONSD compared to patients with CPC 3-5 (5.5mm vs 6.1mm, p=0.03). At 72 hour, patients with CPC score of 1-2 had an average reduction in ONSD of 1.6mm verses 0.29mm increase in patients with CPC 3-5. Despite small sample size, a trend towards higher ONSD were seen in patients with non-shockable vs shockable rhythm. Females were also consistently found to have smaller ONSD measurements in all time periods compared to males. Conclusions: This is the first study in the USA to perform analysis using ONSD measurements in cardiac arrest patients. Preliminary analysis of this on-going pilot revealed a greater improvement in ONSD diameters in patients with a favorable neurological outcome. OSND may have utility in prognostication of the post-arrest state.