Document Type : Research articles
Authors
- yavuz selim Divriklioglu Divriklioglu 1
- onur karakayal? 2
- Yavuz Yi?it 3
- serkan yilmaz 4
- Yavuz Birinci 5
- Bora kalaycioglu 6
1 Seka State of Hospital, Emergency Medicine Department, Kocaeli, Turkey
2 Sakarya University, Emergency Medicine Department, Sakarya, Turkey
3 Hamad Medical Corporation, Emergency Medicine Department, Qatar & Blizard Institute, Queen Mary University, London, United Kingdom
4 Kocaeli University, Emergency Medicine Department, Kocaeli , Turkey
5 Fatih State of Hospital, Emergency Medicine Department, Trabzon, Turkey
6 Memorial Sloan Kettering Cancer Center, Radiology Department, New York, USA
Abstract
Introduction: Stroke is the leading cause of high mortality rates in the emergency department (ED). In this regard, early diagnosis and starting appropriate treatments are important. We aimed to evaluate the efficiency of the optic nerve sheath diameter (ONSD) in the detection of ischemic cerebrovascular disease on initial brain computerized tomography (CT) images of patients presented with ischemic stroke clinic to ED.
Method: In this study, 375 retrospectively-evaluated patients underwent brain CT with a pre-diagnosis of cerebrovascular events, following diffusion magnetic resonance imaging (MRI) due to suspicion of ischemic stroke. Demographic findings, vital signs, Glasgow Coma Scale, National Institute of Health Stroke Scale, Modified Rankin Scale. The results of brain CT as well as diffusion magnetic resonance imaging (MRI) were noted. The measurement of ONSD was done at 3 mm behind the optic disc from both eyes from the initial brain CT of the patients.
Results: In this study, 198 out of 375 patients (52.8%) were women. The mean age of patients was obtained at 67.74±13.18 years. According to diffusion MRI, 143 (38.1%) patients experienced ischemic stroke. The mean age of patients with ischemic stroke was 68.75±12.26 years, and 80 (55.9%) patients were women. The mean scores of ONSD with ischemic stroke were 5.14±0.68 and 4.79±0.6 in the control group. In the diagnosis of ischemic stroke, there was a statistically significant difference between the patient and control groups in terms of ONSD.
Conclusion: In CT images of patients with ischemic stroke, ONSD values were found to increase. If ONSD measurement via brain CT correlates with physical examination and clinical signs, it can be used as an indicator in the diagnosis of early-term ischemic stroke.
Keywords
- Ünüvar N, Mollahaliloğlu S, Yardım N. Türkiye hastalık yükü çalışması 2004. TC Sağlık Bakanlığı, Refık Saydam Hıfzıssıhha Merkezı Başkanlığı, Hıfzıssıhha Mektebi Müdürlüğü. 1Basım. Ankara: Aydoğdu Ofset Matbaacılık San. ve Tic. Ltd. Şti. 2006:1-56.
- Marx J, Hockberger R, Walls R. Rosen's Emergency Medicine-Concepts and Clinical Practice E-Book .Elsevier Health Sciences. 2013.
- Na DG, Kim EY, Ryoo JW, Lee KH, Roh HG, Kim SS, Song IC, Chang KH. CT sign of brain swelling without concomitant parenchymal hypoattenuation: comparison with diffusion- and perfusion-weighted MR imaging. Radiology. 2005;235(3):992-48. doi: 10.1148/radiol.2353040571. [PubMed: 15860675].
- Liu D, Kahn M. Measurement and relationship of subarachnoid pressure of the optic nerve to intracranial pressure in fresh cadavers. Am J Ophthalmol. 1993;116(5):548-56. doi: 10.1016/s0002-9394(14)73195-2. [PubMed: 8238213].
- Launey Y, Nesseler N, Le Maguet P et al. Effect of osmotherapy on optic nerveheath diameter in patients with increased intracranial pressure. J Neurotrauma. 2014;31(10):984-8. doi: 10.1089/neu.2012.2829. [PubMed: 24372319].
- Ballantyne SA, O’Neill G, Hamilton R, Hollman AS (2002) Observer variation in the sonographic measurement of optic nerve sheath diameter in normal adults. Eur J Ultrasound. 2002;15(3):145-9. doi: 10.1016/s0929-8266(02)00036-8. [PubMed: 12423741].
- Wilberger JE Jr. Outcomes analysis: intracranial pressure monitoring. Clin Neurosurg. 1997;44:439–48. [PubMed: 10080020].
- Bekerman I, Sigal T, Kimiagar I, Almer ZE, Vaiman M. Diagnostic value of the optic nerve sheath diameter in pseudotumorcerebri. J Clin Neurosci. 2016;30:106-9. doi: 10.1016/j.jocn.2016.01.018. [PubMed: 27168453].
- Kimberly HH, Shah S, Marill K, Noble V Correlation of optic nevre sheath diameter with direct measurement of intracranial pressure. Acad Emerg Med. 2008;15(2):201-4. doi: 10.1111/j.1553-2712.2007.00031.x. [PubMed: 18275454].
- Şafak KY, Türkoğlu Ö, Şencan BD, et al. Optik Sinir Kılıfı Çapı Ölçümlerinde MRG ve USG Arasındaki Uyum. Okmeydanı Tıp Dergisi. 2015;31(2):71-74. doi: 10. 5222/otd.2015.071.
- Gökcen E, Caltekin İ, Savrun A, Korkmaz H, Savrun ŞT, Yıldırım G. Alterations in optic nerve sheath diameter according to cerebrovascular disease sub-groups. Am J Emerg Med. 2017;35(11):1607-1611. doi: 10.1016/j.ajem.2017.04.073. 30. [PubMed: 28473274].
- Hassen GW, Bruck I, Donahue J, Mason B, Sweeney B, Saab W et al. Accuracy of optic nerve sheath diameter measurement by emergency physicians using bedside ultrasound. J Emerg Med. 2015;48(4):450-7. doi: 10.1016/j.jemermed.2014.09.060. [PubMed: 25497897].
- Hyung-Chul L, Won-Jong L, Yun-Sik D, et al. Optic nerve sheath diameter based on preoperative brain computed tomography and intracranial pressure are positively correlated in adults with hydrocephalus. Clin Neurol Neurosurg. 2018;167:31-35. doi: 10.1016/j.clineuro.2018.02.012. [PubMed: 29433056].
', './data/ircmj/coversheet/cover_en.jpg'))