Emine AKÇAY, Havva ŞAHİN KAVAKLI, Sema YÜZBAŞIOĞLU, Yücel YÜZBAŞIOĞLU, Selçuk COŞKUN, Tolga ÖZ, Refik KUNT, Sinan BECEL, Ferhat İÇME

Bedside measurement of the optic nerve sheath diameter with ultrasound in cerebrovascular disorders

Background/aim: We aimed to show the role of determination of optic nerve sheath diameter (ONSD) by bedside ultrasonography inan emergency department in the diagnosis of cerebrovascular disorders and its correlation with the clinical picture.Materials and methods: This prospective cross-sectional study included 55 patients with cerebrovascular disorders and 53 controls.Age, sex, ONSD, comorbid disease status, and multidetector computed tomography results of all subjects and application periods andNational Institutes of Health Stroke Scale (NIHSS) scores of the patient group were evaluated.Results: The ONSD of the patient and control groups was determined as a median of 5.7 mm and 3.6 mm, respectively. The ONSDof the patient group was determined to be significantly higher than that of the control group (P < 0.05). A positive relationship wasdetermined between NIHSS scores and ONSD values (P < 0.05). The specificity and sensitivity values were determined as 98.1% and81.8%, respectively, for a cutoff value of 5 mm and as 100% and 72.7%, respectively, for a cutoff value of 6 mm.Conclusion: This study showed that bedside measurement of ONSD is an easy, cheap, and noninvasive method that can be used tosupport the diagnosis and evaluation of patients with acute stroke.

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Woloszyn AV, Schwarz MA. Early management of stroke patients in the emergency department. J Pharm Pract 2011; 24: 160-173.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S et al. Executive summary: heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation 2014; 129: 399- 410.
Go S, Worman DJ. Stroke syndromes. In: Tintinalli JE, editor. Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY, USA: McGraw-Hill; 2015. pp. 1142-1156.
Speck V, Staykov D, Huttner HB, Sauer R, Schwab S, Bardutzky J. Lumbar catheter for monitoring of intracranial pressure in patients with post-hemorrhagic communicating hydrocephalus. Neurocrit Care 2011; 14: 208-215.
Topcuoglu MA, Arsava EM, Das DF, Kozak HH. Transorbital ultrasonographic measurement of optic nerve sheath diameter in brain death. J Neuroimaging 2015; 25: 906-909.
Lang EW, Paulat K, Witte C, Zolondz J, Mehdorn HM. Noninvasive intracranial compliance monitoring. Technical note and clinical results. J Neurosurg 2003; 98: 214-218.
Dubourg J, Messerer M, Karakitsos D, Rajajee V, Antonsen E, Javouhey E, Cammarata A, Cotton M, Daniel RT, Denaro C et al. Individual patient data systematic review and meta-analysis of optic nerve sheath diameter ultrasonography for detecting raised intracranial pressure: protocol of the ONSD research group. Syst Rev 2013; 2: 62.
Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, Elkind MS, George MG, Hamdan AD, Higashida RT et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44: 2064-2089.
Bellner J, Romner B, Reinstrup P, Kristiansson KA, Ryding E, Brandt L. Transcranial Doppler sonography pulsatility index (PI) reflects intracranial pressure (ICP). Surg Neurol 2004; 62: 45-51.
Saz-Saucedo P, Redondo-González O, Mateu-Mateu A, Huertas-Arroyo R, García-Ruiz R, Botia-Paniagua E. Sonographic assessment of the optic nerve sheath diameter in the diagnosis of idiopathic intracranial hypertension. J Neurol Sci 2016; 361: 122-127.
Goeres P, Zeiler FA, Unger B, Karakitsos D, Gillman LM. Ultrasound assessment of optic nerve sheath diameter in healthy volunteers. J Crit Care 2016; 31: 168-171.
Geeraerts T, Launey Y, Martin L, Pottecher J, Vigué B, Duranteau J, Benhamou D. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med 2007; 33: 1704- 1711.
Kimberly HH, Shah S, Marill K, Noble V. Correlation of optic nerve sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med 2008; 15: 201-204.
Francois P, Lescanne E, Velut S. The dural sheath of the optic nerve: descriptive anatomy and surgical applications. Adv Tech Stand Neurosurg 2011; 36: 187-198.
Killer HE, Laeng HR, Flammer J, Groscurth P. Architecture of arachnoid trabeculae, pillars, and septa in the subarachnoid space of the human optic nerve: anatomy and clinical considerations. Br J Ophthalmol 2003; 87: 777-781.
Geeraerts T, Launey Y, Martin L, Pottecher J, Vigué B, Duranteau J, Benhamou D. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intens Care Med 2007; 33: 1704-1711.
Soldatos T, Karakitsos D, Chatzimichail K, Papathanasiou M, Gouliamos A, Karabinis A. Optic nerve sonography in the diagnostic evaluation of adult brain injury. Crit Care 2008; 12: R67.
Sahoo SS, Agrawal D. Correlation of optic nerve sheath diameter with intracranial pressure monitoring in patients with severe traumatic brain injury. Indian Journal of Neurotrauma 2013; 10: 9-12.
Sekhon MS, McBeth P, Zou J, Qiao L, Kolmodin L, Henderson WR, Reynolds S, Griesdale DE. Association between optic nerve sheath diameter and mortality in patients with severe traumatic brain injury. Neurocrit Care 2014; 21: 245-252.
Amini A, Kariman H, Arhami Dolatabadi A, Hatamabadi HR, Derakhshanfar H, Mansouri B, Safari S, Eqtesadi R. Use of the sonographic diameter of optic nerve sheath to estimate intracranial pressure. Am J Emerg Med 2013; 31: 236-239.
Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, Creager MA, Eckel RH, Elkind MS, Fornage M et al. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45: 3754-3832.
Sahan M, Sebe A, Acikalin A, Akpinar O, Koc F, Ay MO, Gulen M, Topal M, Satar S. Acute-phase reactants and cytokines in ischemic stroke: do they have any relationship with shortterm mortality? Eur Rev Med Pharmacol Sci 2013; 17: 2773- 2777.
Fishman RA. Brain edema. N Engl J Med 1975; 293: 706.
Gala F. Magnetic resonance imaging of optic nerve. Indian J Radiol Imaging 2015; 25: 421-38.
Coles WH. Hypertension and retinal vessels. Heart Dis Stroke 1994; 3: 304-308.
Jungkim S, Khurshid SG, Fenton S. Dural ectasia of the optic nerve sheath. Acta Ophthalmol Scand 2005; 83: 266-267.
Mehrpour M, Oliaee Torshizi F, Esmaeeli S, Taghipour S, Abdollahi S. Optic nerve sonography in the diagnostic evaluation of pseudopapilledema and raised intracranial pressure: a cross-sectional study. Neurol Res Int 2015; 2015: 146059.
Watanabe A, Kinouchi H, Horikoshi T, Uchida M, Ishigame K. Effect of intracranial pressure on the diameter of the optic nerve sheath. J Neurosurg 2008; 109: 255-258.
Moretti R, Pizzi B, Cassini F, Vivaldi N. Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. Neurocrit Care 2009; 11: 406-410.
Bauerle J, Nedelmann M. Sonographic assessment of the optic nerve sheath in idiopathic intracranial hypertension. J Neurol 2011; 258: 2014-2019.
Rajajee V, Vanaman M, Fletcher JJ, Jacobs TL. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care 2011; 15: 506-515.
Skoloudík D, Herzig R, Fadrná T, Bar M, Hradílek P, Roubec M, Jelínková M, Sanák D, Král M, Chmelová J et al. Distal enlargement of the optic nerve sheath in the hyperacute stage of intracerebral haemorrhage. Br J Ophthalmol 2011; 95: 217- 221.
Appelros P, Nydevik I, Viitanen M. Poor outcome after firstever stroke. Predictors for death, dependency, and recurrence stroke within the first year. Stroke 2003; 34: 122-126.
German Stroke Study Collaboration. Predicting outcome after acute ischemic stroke. An external validation of prognostic model. Neurology 2004; 62: 581-585.