Measurement of optic nerve sheath diameter on computed tomography for the differentiation of transient ischemic attacks

SUMMARY OBJECTIVE: The objective of this study was to investigate whether the measurement of mean optic nerve sheath diameter in patients with transient ischemic attack could be used to distinguish between control groups, the acute ischemic stroke group, and subgroups within the acute ischemic stroke category. METHODS: Retrospectively, the mean optic nerve sheath diameters of patients aged 18 years and older belonging to control, transient ischemic attack, acute ischemic stroke, and subgroups within the acute ischemic stroke category were measured with initial computed tomography conducted in the emergency department. RESULTS: Out of the 773 patients included in the study, 318 (41.1%) were in the control group, 77 (10%) had transient ischemic attack, and 378 (49%) were categorized as stroke patients. The average mean optic nerve sheath diameter was significantly higher in both the stroke and transient ischemic attack groups compared with the control group (p<0.001 for both comparisons). Furthermore, the mean optic nerve sheath diameter in the stroke subgroups was significantly higher than in both the transient ischemic attack and control groups (p<0.001 for all comparisons). In transient ischemic attack patients, the mean optic nerve sheath diameter showed a significant ability to predict transient ischemic attack (AUC=0.913, p<0.001), with a calculated optimal cutoff value of 4.72, sensitivity of 94.8%, and specificity of 73.9%. CONCLUSION: The mean optic nerve sheath diameter of patients in the transient ischemic attack group was lower compared with those in the stroke subgroups but higher compared with the control group.

The effects of positive end-expiratory pressure (PEEP) application on optic nerve sheath diameter in patients undergoing laparoscopic cholecystectomy: a randomized trial

Abstract Background: Positive end-expiratory pressure (PEEP) can overcome respiratory changes that occur during pneumoperitoneum application in laparoscopic procedures, but it can also increase intracranial pressure. We investigated PEEP vs. no PEEP application on ultrasound measurement of optic nerve sheath diameter (indirect measure of increased intracranial pressure) in laparoscopic cholecystectomy. Methods: Eighty ASA I-II patients aged between 18 and 60 years scheduled for elective laparoscopic cholecystectomy were included. The study was registered in the Australian New Zealand Clinical Trials (ACTRN12618000771257). Patients were randomly divided into either Group C (control, PEEP not applied), or Group P (PEEP applied at 10 cmH20). Optic nerve sheath diameter, hemodynamic, and respiratory parameters were recorded at six different time points. Ocular ultrasonography was used to measure optic nerve sheath diameter. Results: Peak pressure (PPeak) values were significantly higher in Group P after application of PEEP (p = 0.012). Mean respiratory rate was higher in Group C at all time points after application of pneumoperitoneum (p < 0.05). The mean values of optic nerve sheath diameters measured at all time points were similar between the groups (p > 0.05). The pulmonary dynamic compliance value was significantly higher in group P as long as PEEP was applied (p = 0.001). Conclusions: During laparoscopic cholecystectomy, application of 10 cmH2O PEEP did not induce a significant change in optic nerve sheath diameter (indirect indicator of intracranial pressure) compared to no PEEP application. It would appear that PEEP can be used safely to correct

Ecografía de nervio óptico para estimar hipertensión intracraneal en pacientes adultos con neurotrauma

Introducción: El neurotrauma es una condición que puede dar paso a una hipertensión intracraneana, situación que es muy grave. Los métodos diagnósticos de elección son los invasivos, aun así, los no invasivos y entre ellos la ecografía del nervio óptico, ofrecen muchísimas ventajas. Objetivo: Describir elementos esenciales de la ecografía de nervio óptico como método para diagnosticar hipertensión intracraneal en pacientes adultos con neurotrauma. Métodos: Se hizo una revisión de la literatura más reciente sin restricción lingüística o geográfica en las bases de datos PubMed y SciELO, se usaron términos afines al tema del artículo y se realizó una valoración crítica sobre la bibliografía consultada. Resultados: La literatura disponible sobre la ecografía del nervio óptico en la determinación de la hipertensión intracraneal es abundante y la mayoría apunta a sus beneficios como método no invasivo. La principal debilidad del mismo es que no es capaz de dar un valor exacto y esto se debe a que el valor normal del diámetro de la vaina del nervio óptico por cada persona puede variar significativamente. La proporción directa entre el diámetro de la vaina del nervio óptico y la presión intracraneal es un hecho que ningún autor intenta invalidar. Conclusiones: La ecografía del nervio óptico es un método seguro, accesible económicamente, no invasivo, fácil de usar y con un valor predictivo confiable para determinar la hipertensión intracraneal.

Introduction: Neurotrauma is a condition that can lead to intracranial hypertension, which is a very serious situation. The diagnostic methods of choice are the invasive ones, even so, the non-invasive ones offer many advantages, the ultrasound of the optic nerve is among them. Objective: To describe essential elements of optic nerve ultrasound as a method to diagnose intracranial hypertension in adult patients with neurotrauma. Methods: A review of the most recent literature was made without linguistic or geographical restrictions in databases such as PubMed and SciELO, terms related to the theme of the manuscript were used. A critical assessment of the consulted bibliography was made. Results: The available literature on optic nerve ultrasound in the determination of intracranial hypertension is abundant and most points to the benefits as a non-invasive method. However, its main weakness lies in the fact that it is not capable of giving an exact value, due to the fact that the normal value of the diameter of the optic nerve sheath for each person can vary significantly. The direct relationship between optic nerve sheath diameter and intracranial pressure is a fact that no author attempts to invalidate. Conclusions: Optic nerve ultrasound is a safe, affordable, non-invasive, easy-to-use method with a reliable predictive value to determine intracranial hypertension.

Contribución de los hallazgos tomográficos al diagnóstico de la hipertensión intracraneal en el traumatismo craneoencefálico grave

Introducción: El traumatismo craneoencefálico es responsable de más de 500 000 visitas a departamentos de urgencias, 95 000 hospitalizaciones y 7 000 muertes en la población infantil. La monitorización clínica se apoya en técnicas imagenológicas, entre otras. Objetivo: Relacionar los hallazgos tomográficos encontrados, a través de la clasificación de Marshall al ingreso y diámetro de la vaina del nervio óptico y su asociación con la presión intracraneal y con los resultados en el paciente pediátrico con traumatismo craneoencefálico grave. Métodos: Estudio descriptivo prospectivo con todos los pacientes pediátricos aquejados de traumatismo craneoencefálico grave entre enero de 2003 y diciembre de 2017. Resultados: De los 41 casos, se encontró relación entre los niveles de presión intracraneal y el grado de luxación de la línea media >10 mm en 10 enfermos (62,5 %) y con el diámetro de la vaina del nervio óptico (>5,5 mm) por tomografía de cráneo en 12 (75,0 %), igualmente existió relación entre esas dos variables con los resultados a los 6 meses de evolución. Conclusiones: La utilización de la tomografía de cráneo simple como herramienta para la determinación de variables utilizadas en el monitoreo no invasivo de la presión intracraneal como son la clasificación tomográfica de Marshall, la luxación de la línea media y la medición del diámetro de la vaina del nervio óptico, permite identificar incrementos de la presión intracraneal. Esto pudiera utilizarse para el tratamiento intensivo de los pacientes pediátricos con traumatismo cráneo encefálico grave, sin necesidad de la utilización de monitoreo invasivo en ellos.

Introduction: Traumatic brain injury is responsible for more than 500,000 visits to the emergency services, 95,000 hospitalizations and 7,000 deaths in children. Clinical monitoring is based on imaging techniques, among others. Objective: To relate the tomographic findings found, through Marshall's classification at the entrance and diameter of the optic nerve sheath and its association with intracranial pressure and with the results in the pediatric patient with severe head trauma. Methods: Prospective descriptive study with all pediatric patients suffering from severe head trauma between January 2003 and December 2017. Results: Of the 41 cases, a relationship was found between the levels of intracranial pressure and the degree of dislocation of the midline >10 mm in 10 patients (62.5%) and with the diameter of the optic nerve sheath (>5.5 mm) by skull tomography in 12 (75.0%); there was also a relationship between these two variables with the results at 6 months of evolution. Conclusions: The use of simple tomography of the skull as a tool for the determination of variables used in the non-invasive monitoring of intracranial pressure such as Marshall tomographic classification, midline dislocation and measurement of the diameter of the optic nerve sheath, allows to identify increases in intracranial pressure. This could be used for the intensive treatment of pediatric patients with severe head trauma, without the need for invasive monitoring in them.

Ultrasonografía del diámetro de la vaina del nervio óptico en paciente con meningoencefalitis complicada / Ultrasonography of the optic nerve sheath diameter in patient with complicated meningoencephalitis

RESUMEN La ultrasonografía del diámetro de la vaina del nervio óptico es un método no invasivo para monitorizar la presión intracraneal. Se ha utilizado en múltiples patologías neurocríticas, incluyendo la infección complicada del sistema nervioso central. Se presenta el caso de una paciente femenina de 47 años, quien ingresó en la Unidad de Cuidados Intensivos luego de presentar progresión al estado comatoso secundario a cuadro de meningoencefalitis bacteriana. Al ingreso se constata midriasis bilateral arreactiva, ausencia parcial de reflejos del tallo encefálico y bradicardia. Ante la sospecha clínica de hipertensión intracraneal, se indica ultrasonografía del diámetro de la vaina del nervio óptico en plano axial. Se realizaron tres mediciones para cada ojo, mostrando un valor de 6,3, 6,6 y 6,00 mm en ojo derecho, y 6,8, 6,6 y 6,8 mm en el izquierdo (promedio biocular: 6,5 mm). Con esta medición se complementó el diagnóstico sospechado. Esta técnica representa un proceder seguro y no invasivo. Su uso completa los datos recogidos en el examen clínico. El punto de corte universalmente aceptado para el diagnóstico es de 5,0 mm o más para un valor de presión intracraneal > 20 mmHg.

ABSTRACT The optic nerve sheath ultrasonography is a non-invasive method for monitoring intracranial pressure. It has been used in multiple neurocritical pathologies, including the complicated infection of the central nervous system. The case of a 47-year-old female patient is presented; she was admitted to the Intensive Care Unit after presenting progression to comatose state secondary to bacterial meningoencephalitis. On admission, bilateral arreactive mydriasis, partial absence of brainstem reflexes and bradycardia are confirmed. Given the clinical suspicion of intracranial hypertension, ultrasonography of the optic nerve sheath diameter in the axial plane is indicated. Three measurements were made for each eye, showing a value of 6.3, 6.6 and 6.00 in the right eye, and 6.8, 6.6 and 6.8 in the left one (biocular average: 6.5 mm). With this measurement the suspected diagnosis was completed. This technique represents a secure and non-invasive procedure. Its use completes the data collected in the clinical examination. The universally accepted cut-off point for diagnosis is 5.0 mm or more for an intracranial pressure value of > 20 mmHg.

Glasgow coma score combined with optic nerve sheath diameter in predicting the risk of death from cerebrocardiac syndrome / 中华急诊医学杂志

Objective:To explore the value of Glasgow coma score (GCS) combined with optic nerve sheath diameter (ONSD) in predicting the death risk of patients with cerebrocardiac syndrome (CCS).Methods:From January 2021 to September 2021, 83 patients with CCS secondary to severe traumatic brain injury (sTBI) in our hospital were collected and divided into a survival group ( n = 37) and death group ( n = 46) according to CCS-related death. The clinical data including age, sex, underlying diseases, head CT imaging manifestations, electrolytes, blood glucose, C-reactive protein (CRP), neuron-specific enolase (NSE), lactate dehydrogenase (LDH), creatine kinase (CK), creatine phosphokinase isoenzyme (CKMB), intracranial pressure (ICP), ONSD, cardiac color ultrasound, acute physiology and chronic health evaluationII (APACHEⅡ ) and GCS were analyzed and compared between the two groups. The proportion and dosage of vasoactive drugs used at admission, daily fluid balance volume during hospitalization, total amount of sedative and analgesic drugs, and average daily dose were analyzed and compared between the two groups. The independent risk factors for CCS-related death were analyzed using multivariate logistic regression. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of the independent risk factors in CCS-related death. Results:In this study, 55.4% of the patients died of CCS. The ONSD, ICP change rate, right ventricular Tei index and NSE in the death group were higher than those in the survival group, with statistically significant differences ( P < 0.05), while the GCS in the death group was significantly lower than that in the survival group, with a statistically significant difference ( P < 0.01). ONSD ( OR = 23.890, 95% CI: 5.526-103.286, P < 0.001), GCS ( OR = 17.066, 95% CI: 1.476-197.370, P = 0.023) and ICP change rate ( OR = 0.060, 95% CI: 0.007-0.477, P = 0.008) were the independent risk factors for CCS-related death. The area under the ROC curve (AUC = 0.897) of ONSD combined with GCS in evaluating CCS-related death was larger than that of ONSD, ICP change rate alone and the corresponding AUC of 1/GCS (0.876, 0.785, 0.800, respectively), with the advantages of non-invasive, dynamic monitoring and low inspection costs. Conclusions:The mortality rate of CCS is high. ONSD, GCS and ICP change rates are independently correlated with the death of CCS patients. ONSD combined with GCS is an ideal indicator for clinical prediction of CCS-related death.

Effects of different doses of dexmedetomidine on intracranial pressure in patients undergoing gynecological laparoscopic surgery / 中国药房

OBJECTIVE To investigate the effects of different doses of dexmedetomidine on intracranial pressure in patients undergoing gynecological laparoscopic surgery. METHODS Ninety patients undergoing selective gynecological laparoscopic surgery in trendelenburg position were divided into low-dose experimental group （group D 1），high-dose experimental group （group D 2） and control group （group C ）according to random number table ，with 30 cases in each group. Group D 1 and group D 2 received continuous intravenous infusion of dexmedetomidine 1.0 μ g/kg for 10 min for induction of anesthesia ，and then continued intravenous infusion at the rate of 0.4 μg（/ kg·h）and 0.6 μg（/ kg·h）respectively. Group C was continuously pumped with the constant volume of Sodium chloride injection. Three groups stopped pumping 30 minutes before the end of the operation. The heart rate（HR）and mean arterial pressure （MAP）were recorded when entering the room （T0），10 min after intravenous pump of dexmedetomidine（T1），10 min（T2），30 min（T3），60 min（T4）after pneumoperitoneum ，10 min after pneumoperitoneum was closed to restore the supine position （T5）. At the same time ，optic nerve sheath diameter （ONSD）in both eyes was measured by ultrasound，and the occurrence of intraoperative bradycardia and the use of atropine were recorded. RESULTS There was no statistical significance in ONSD ，HR or MAP among 3 groups at T 0（P＞0.05）. Compared with T 0，ONSD of 3 groups were decreased significantly at T 1（except for group C ）；ONSD of 3 groups were increased significantly at T 2-T5，while MAP and HR were all decreased significantly （P＜0.05）. HR of group D 2 was decreased significantly at T 1（P＜0.05）. Compared with group C ， ONSD and HR of group D 1 and D 2 were all decreased significantly at T 1-T5（P＜0.05）. Compared with group C ，the number of patients with bradycardia and those who used atropine in group D 1 and D 2 were increased significantly （P＜0.05）. CONCLUSIONS Continuous pumping of dexmedetomidine during gynecologic laparoscopic surgery can reduce the increase of intracranial pressure in patients ；compared with pumping rate of 0.6 μg（/ kg·h），the change of patient ’s HR tends to be more stable with a pumping rate of 0.4 μg（/ kg·h）.

Evaluation of the effect of propofol and desflurane on intracranial pressure in patients undergoing gynecological laparoscopic surgery based on the ratio of diameter of optic nerve sheath to transverse diameter of eyeball / 中国临床药理学与治疗学

AIM: To evaluate the effects of propofol and desflurane on intracranial pressure in patients undergoing gynecological laparoscopic surgery by measuring the ratio of optic nerve sheath diameter (ONSD) to transverse diameter of the eye (ETD). METHODS: Forty patients, scheduled for elective gynecological endoscopic surgery, were randomly divided into propofol group (group P) and desflurane group (group D) (n b 20). Anesthesia maintenance: propofol was injected intravenously in group P, desflurane was inhaled in group D. Remifentanil was injected intravenously and rocuronium was added on schedule. The patients were mechanically ventilated in volume-controlled mode. ETD was recorded after induction of anesthesia. ONSD, HR, MAP, peak airway pressure (Ppeak) and P

Investigation of intracranial pressure in intensive care unit patients with delirium assessed by bedside ultrasound / 中华危重病急救医学

Objective:To explore the changes of intracranial pressure in intensive care unit (ICU) patients during the occurrence and evolution of delirium by using bedside ultrasound to measure the optic nerve sheath diameter (ONSD) to evaluate intracranial pressure.Methods:A retrospective observational study was conducted. Adult patients who developed delirium during hospitalization in the general ICU of Beihai People's Hospital from October 2020 to November 2021 were enrolled, and patients who did not have ultrasonographic ONSD records within 24 hours after the diagnosis of delirium were excluded. The ONSD measured before delirium was recorded as ONSD 0, the ONSD measured within 24 hours of the onset of delirium recorded as ONSD 1, and the ONSD reexamined after ONSD 1 recorded as ONSD 2. Patients were divided into intracranial hypertension group (ONSD 1 > 5 mm) and normal intracranial pressure group (ONSD 1 ≤ 5 mm) according to the size of ONSD 1. According to the outcome of delirium, the patients were divided into cured, improved, and non-improved groups. The reduction ratio of ONSD 2 to ONSD 1 in the three groups were calculated and compared. Pearson correlation test was used to analyze the correlation between fluid balance and ONSD changes after delirium. Results:There were 43 patients, including 40 cases in the intracranial hypertension group (the incidence rate was 93.0%), 3 cases in the normal intracranial pressure group, 23 cases were cured, 13 cases were improved, and 7 cases were not improved. In the intracranial hypertension group, 11 cases had ONSD 0 and ONSD 1 records, and ONSD 1 was significantly higher than ONSD 0 [mm: 5.88±0.61 vs. 5.34±0.57, 95% confidence interval (95% CI) -0.85 to -0.23, P = 0.003]. The reduction ratio of ONSD 2 to ONSD 1 in the cured group was significantly higher than that in the improved group and the non-improved group [(12.04±6.20)% vs. (5.68±4.10)%, (0.17±3.96)%; 95% CI were 2.37 to 10.33, 6.41 to 17.31, P values were 0.003 and 0.000, respectively]. The correlation analysis showed that the reduction ratio of ONSD 2 to ONSD 1 was negatively correlated with fluid balance ( r = -0.42, 95% CI was -0.66 to -0.10, P = 0.012). Conclusions:The incidence of intracranial hypertension in ICU delirium patients is high. A more pronounced decrease in intracranial pressure predicts a better delirium outcome. Dynamic ONSD measurement can provide valuable information for the prevention and treatment of delirium.

Current progress in the treatment of nonarteritic anterior ischemic optic neuropathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#Nonarterial anterior ischemic optic neuropathy(NAION)is a group of common optic nerve diseases that seriously endanger visual function. It is resulted from insufficient perfusion of the posterior ciliary artery, which causes acute ischemia, structural and functional disorders of the optic nerve, and ultimately leads to hypopsia and even vision loss. The etiology and pathogenesis of this disease is complex. It is nowadays considered that multiple factors including local anatomy, risk of systemic vascular cause this disease together, which result in no clear, unified and recognized treatment. Early detection, diagnosis and treatment are of great significance in the prognosis of NAION. Possible therapeutic methods include etiological treatment, drug therapy, traditional Chinese medicine(TCM)treatment, combined medication, optic nerve sheath decompression, adjuvant treatments and exosomes. With the continuous development and application of various anti-NAION drugs in recent years, a variety of therapeutic methods have been proposed, especially with the exosomes as the research focus. In order to better treat NAION with improvement of the cure rate and guidance for clinical work, this paper mainly reviews the progress in the treatment of NAION in recent years.

Medición de la vaina del nervio óptico mediante tomografía computarizada como predictor de mortalidad en pacientes con traumatismo craneoencefálico grave al ingreso a la Unidad de Cuidados Intensivos / Optic nerve sheath measurement through computerized scan as death predictor in patients with serious cranioencephalic trauma on entry to the Intensive Care Unit / Medição da bainha do nervo óptico por tomografia computadorizada como preditor de mortalidade em pacientes com trauma cranioencefálico grave internados na Unidade de Terapia Intensiva

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Abstract: Introduction: Traumatic brain injury (TBI) is a medical-surgical condition characterized by brain involvement secondary to a traumatic lesion. Patients with severe TBI are at high risk of mortality and this will depend on different factors such as the presence of intracranial hypertension, age, origin of the injury and score on the Glasgow coma scale. Measurement of the optic nerve sheath diameter (ONSD) appears to be a good indirect indicator of intercranial hypertension and therefore, a good predictor of mortality. Objective: To determine the most appropriate cut-off point, as well as the measurement of the ONSD usefulness as a prognostic indicator of mortality in patients with severe TBI in the Intensive Care Unit (ICU). Material and methods: This is an analytical, descriptive, and retrospective study. The universe of study consists of all the case/files with TBI. For the sample selection, all available records of patients with severe TBI sent to the ICU during the period from March 1 to August 31, 2021, will be included. Within the inclusion criteria patients with a Glasgow scale score of < 8 points on entry and with a computerized scan done. The dependent variables to considerer are the outcome understood as death or survival of the patient, the days hospitalized in the ICU, the presence of complications; among the dependent variables is the diameter of the optic nerve sheath measured by computerized tomography. Intervening variables were also considered such as the presence of comorbidities and overweight/obesity, the age and sex of the patient. The project consisted of four phases: 1) request for authorization and access to files, 2) application of selection criteria, 3) performance of ONSD measurements and 4) creation of the database. Finally, once the database is formed, the statistical analysis will proceed; for the descriptive part, prevalence's, means (standard deviation) and medians (percentiles) will be calculated for the variables by sex and by outcome, subsequently the diagnostic capacity of the ONSD will be analyzed through the area under the ROC curve (receiving operating characteristics) for the outcome. Afterwards the performance of this and other cut-off points are compared using the Youden index. Results: Sixty records of TBI patients admitted to the ICU were studied, 51 were men (85%), 45 patients survived (75%) and 15 patients died (25%). The average age was of 50.5 ± 10.6 years, the average Glasgow score on admission was 6.6 ± 1.6 points, the average BMI was 26.42 ± 4.10 kg/m2, and the average number of days spent in the ICU was 9.03 ± 6.4. The diameter of the optic nerve was not a predictor of mortality, but if the Glasgow coma scale was, with an AUC of 0.775 (95% CI: 0.648-0.901, p = 0.002), the best cut-off point was 7 with a sensitivity of 93% and specificity of 54%. The bivariate linear regression model points to low Glasgow coma score and long hospital stay as predictors of mortality. Conclusions: The results of this study infer that, consistent with current scientific evidence, the sociodemographic characteristics of our population are similar to those reported by other authors, with men over 50 years of age being the most affected by this entity. On the other hand, the measurement of the diameter of the optic nerve sheath has been considered a good prognostic indicator of intracranial hypertension, which in turn is associated with increased mortality. However, in the present study there is no association between the diameter of the optic nerve sheath and the prognosis of mortality.

Resumo: Introdução: O traumatismo cranioencefálico (TCE) é uma condição médico-cirúrgica caracterizada por lesão cerebral secundária a uma lesão traumática. Pacientes com TCE grave apresentam alto risco de mortalidade e isso dependerá de diversos fatores, como presença de hipertensão intracraniana, idade, origem da lesão e pontuação na Escala de Coma de Glasgow. A medida do diâmetro da bainha do nervo óptico (DBNO) parece ser um bom indicador indireto de hipertensão intracraniana e, portanto, um bom preditor de mortalidade. Objetivo: Determinar o ponto de corte mais adequado, bem como a utilidade da medida do DBNO como indicador prognóstico de mortalidade em pacientes com TCE grave na Unidade de Terapia Intensiva. Material e métodos: Trata-se de um estudo analítico, descritivo e retrospectivo. O universo de estudo é composto por todos os prontuários de casos/pacientes com TCE grave. Para a seleção da amostra foram incluídos todos os prontuários disponíveis de pacientes com TCE grave encaminhados à Unidade de Terapia Intensiva no período de 1o de março a 31 de agosto de 2021, dentro dos critérios de inclusão foram considerados pacientes com escala de Glasgow < 8 pontos na admissão e com uma tomografia computadorizada realizada. As variáveis ​​dependentes consideradas são o desfecho entendido como óbito ou sobrevida do paciente, os dias de internação na UTI, a presença de complicações; dentro das variáveis ​​independentes está o diâmetro da bainha do nervo óptico medido por tomografia computadorizada. Também foram consideradas variáveis ​​intervenientes, como presença de comorbidades e sobrepeso/obesidade, idade e sexo do paciente. O projeto consistiu em três fases: a) Pedido de autorização e acesso aos prontuários, b) Aplicação dos critérios de seleção, c) Desenvolvimento da base de dados. Por fim, uma vez formada a base de dados, procedeu-se à análise estatística. Para a parte descritiva, foram calculadas as prevalências, médias (desvio padrão) e medianas (percentis) das variáveis ​​por sexo e por desfecho. Posteriormente, a capacidade diagnóstica do DBNO foi analisada pela área sob a curva ROC (Receiving Operating Characteristics) para o resultado. Posteriormente, o desempenho deste e de outros pontos de corte foi comparado pelo índice de Youden. Resultados: Foram estudados 60 prontuários de pacientes com TCE que deram entrada na UTI, 51 eram homens (85%), 45 pacientes sobreviveram (75%) e 15 pacientes morreram (25%). A média de idade foi de 50.5 ± 10.6 anos, a média de Glasgow na admissão foi de 6.6 ± 1.6 pontos, a média de IMC foi de 26.42 ± 4.10 kg/m2 e a média de dias de internação na UTI foi de 9.03 ± 6.4. O diâmetro do nervo óptico não foi preditor de mortalidade, mas a Escala de Coma de Glasgow sim, com AUC de 0.775 (IC 95%: 0.648-0.901, p = 0.002), o melhor ponto de corte foi 7 com sensibilidade de 93% e especificidade de 54%. O modelo de regressão linear bivariada aponta para baixo escore de coma de Glasgow e longa permanência hospitalar como preditores de mortalidade. Conclusões: Os resultados deste estudo inferem que, de acordo com as evidências científicas atuais, as características sociodemográficas de nossa população são semelhantes às relatadas por outros autores, sendo os homens com aproximadamente 50 anos de idade os mais acometidos por essa entidade. Por outro lado, a medida do diâmetro da bainha do nervo óptico tem sido considerada um bom indicador prognóstico de hipertensão intracraniana, que por sua vez está associada ao aumento da mortalidade. No entanto, no presente estudo não há associação entre o diâmetro da bainha do nervo óptico e o prognóstico de mortalidade.

Ultrasonografía del diámetro de la vaina del nervio óptico en el monitoreo de la presión intracraneal / Ultrasound of optic nerve sheath diameter for monitoring intracranial pressure

Introducción: El neuromonitoreo no invasivo en pacientes críticos representa una opción de primera línea para el manejo de complicaciones fatales derivadas del aumento de la presión intracraneal. En esta modalidad se incluye la ultrasonografía del diámetro de la vaina del nervio óptico, la cual representa una técnica rápida, fácil de realizar y disponible a la cabecera del paciente. Objetivos: Describir aspectos fundamentales y actualizados sobre el uso de la ultrasonografía en el monitoreo de la presión intracraneal a través de la medición del diámetro de la vaina del nervio óptico en los diferentes escenarios neuroclínicos. Métodos: Se realizó una revisión de la literatura publicada en bases de datos como: PubMed/Medline, SciELO y Google académico entre los meses mayo y julio de 2020. Se revisaron publicaciones en inglés y español. Se seleccionaron 46 bibliografías que cumplieron con los criterios de inclusión. Se describen aspectos fundamentales como la anatomía ecográfica del nervio óptico, descripción de la técnica y su uso en entidades neurocríticas como el traumatismo craneoencefálico, ictus, muerte encefálica, entre otros. Conclusiones: La ecografía de la vaina del nervio óptico representa una alternativa no invasiva ampliamente aceptada para la medición del incremento de la presión intracranial. Con un diámetro de 5,0 hasta 5,9 mm o más se puede asumir el diagnóstico de hipertensión intracraneal con alta sensibilidad y especificidad, aunque debe individualizarse su uso en cada patología neurocrítica. La curva de aprendizaje para la realización del proceder es de breve tiempo y satisface las habilidades necesarias(AU)

Introduction: Noninvasive neuromonitoring in critically ill patients is a first-line option for the management of fatal complications derived from increased intracranial pressure. This modality includes ultrasound of optic nerve sheath diameter, which is a quick technique, easy to perform and available at the bedside. Objectives: To describe significant and state-of-the-art aspects regarding the use of ultrasound for monitoring intracranial pressure through measurement of the optic nerve sheath diameter in different neuroclinical settings. Methods: A review was carried out, between May and July 2020, of the literature published in databases such as PubMed/Medline, SciELO and Google Scholar. Publications in English and Spanish were reviewed. Forty-six bibliographic sources were chosen, as long as they met the inclusion criteria. Fundamental aspects are described, such as the ultrasound anatomy of the optic nerve, the technique procedures and its use in neurocritical entities such as head trauma, stroke and brain death, among others. Conclusions: Ultrasound of the optic nerve sheath is a widely accepted noninvasive choice for measurement of increased intracranial pressure. With a diameter of 5.0 to 5.9 mm or more, the diagnosis of intracranial hypertension can be assumed with high sensitivity and specificity, although its use should be individualized in each neurocritical pathology. The learning curve for carrying out the procedure is short and satisfies the necessary skills(AU)

Predictive value of optic nerve sheath diameter in the risk of death in patients with severe brain injury / 中华急诊医学杂志

Objective:To explore the value of ultrasonic measurement of optic nerve sheath diameter (ONSD) in predicting the risk of death in patients with severe brain injury.Methods:This was a prospective observational study based on 84 postoperative patients with severe brain injury from January 2020 to September 2020 in our department. The patients were divided into two groups: the survival group and the deceased group. The clinical features between the two groups were compared. Receiver operating characteristic (ROC) curves were used to evaluate the sensitivity and specificity of ONSD, neuron-specific enolase (NSE) and the combination of the two in predicting death in patients with severe brain injury. Binary logistic regression was used to analyze the independent risk factors for death. A prediction model for the risk of death was constructed.Results:There were 61 cases (72.6%) in the survival group and 23 cases (27.4%) in the deceased group. There were significant differences in age, Glasgow coma score (GCS), ONSD and NSE at 12 h after surgery between the two groups. According to the ROC curve, the optimal cutoff levels of ONSD and NSE for predicting death were 5.5 mm and 21.75 ng/mL, respectively. When the two indicators were combined, the area under the curve was 0.897 ( P<0.01). At this threshold, the sensitivity and specificity were 100% and 70.5%, respectively. ONSD ( OR=9.713; 95% CI: 1.192-79.147) and GCS scores ( OR=0.492; 95% CI: 0.318-0.763) at 12 h after surgery were independent risk factors for death in patients with severe brain injury (both P<0.05). Conclusions:Early postoperative ONSD is an independent risk factor for death in patients with severe brain injury. The combination of ONSD and NSE has the best predictive effect.

Clinical efficacy of restrictive fluid management in patients with severe traumatic brain injury / 南方医科大学学报

OBJECTIVE@#To investigate the effects of restrictive fluid management in patients with severe traumatic brain injury (sTBI).@*METHODS@#Between January, 2019 and June, 2020, we randomly assigned 51 postoperative patients (stay in the ICU of no less than 7 days) with sTBI into treatment group (@*RESULTS@#The cumulative fluid balance of the two groups were positive on day 1 and negative on days 3 and 7 after ICU admission; at the same time points, the patients in the treatment group had significantly greater negative fluid balance than those in the control group (@*CONCLUSIONS@#Restrictive fluid management can reduce cerebral edema and improve the prognosis but does not affect the 28-day mortality of patients with sTBI.

Increase in optic nerve sheath diameter predicts early cerebral involvement in fat embolism syndrome / 中华创伤杂志(英文版)

Early diagnosis of cerebral fat embolism in a patient with contradiction to MRI is challenging. Here we report an interesting case, where the raised optic nerve sheath diameter helped us to predict the early cerebral involvement with fat emboli in a left femoral shaft fracture patient. MRI scan could not be performed due to the presence of a metallic implant in the patient from a previous surgery. He was later diagnosed as an atypical presentation of fat embolism syndrome. Optic nerve sheath monitoring also helped us to guide further management of the patient.

Association between potential intracranial pressure and optic nerve sheath diameter evaluated by transcranial Doppler and ultrasonographic measurement in encephalitis patients / 中国脑血管病杂志

Objective To explore the association between potential intracranial pressure (ICP) and optic nerve sheath diameter ( ONSD) evaluated by transcranial Doppler( TCD) and ultrasonographic measurement in encephalitis patients. Methods A total of 17 patients with encephalitis received lumbar puncture were enrolled continuously in the Department of Neurology and Neuroscience of the First Hospital of Jilin University from October 2019 to January 2020. The ONSD and TCD examinations were performed before the operation of lumbar puncture, and the relevant data were recorded. All patients were divided into the elevated ICP group (more than 200 mmH2O) (n = 10 ) , the normal ICP group (80 -200mmH2O) (n=7) according to the results of the initial ICP. The difference of baseline data, ONSD, and the parameters of TCD such as peak systolic velocity (PSV) , end-diastolic velocity ( EDV) , mean blood flow velocity (MV) , and pulse index (PI) , were compared between the two groups. Moreover, the correlation between ICP and ONSD was analyzed. Results (1 ) The difference of gender, age, body mass index, systolic blood pressure, and diastolic blood pressure was not statistically different between the normal and the elevated ICP groups (all P >0. 05). The ONSD was significantly lower in the normal ICP group compared with that in the elevated ICP group ([4.2±0.4] mm vs. [ 4.9 ± 0.4 ] mm, t = - 3. 873, P = 0.002). (2) TCD related parameters (PSV, EDV, MV and PI) were not significantly different between the elevated ICP group and the normal ICP group (all P >0. 05). (3) Univariate analyses revealed that ICP was significantly associated with ONSD (r =0. 87 ,P < 0. 01). Conclusion Results of the study indicate that ONSD is a predictive index for elevated ICP in encephalitis patients.

Non-Invasive Intracranial Pressure Evaluation in an Emergency Room ­ Point-of-Care Ultrasonography

Point-of-care ultrasound ismodifying conducts in emergency care. The variousmedical specialties, in addition to traditional indications in cases of multiple trauma, are using this technique for rapid diagnosis at the bedside without patient mobilization and without radiation. Point-of-care ultrasound in neurocritical patients, through its transorbital window, can estimate the intracranial pressure by a non-invasive method. Through the measurement of the diameter of the optic nerve sheath 3mmposterior to the retina, the intracranial pressure is estimated if the value of the diameter is >5mm, as it has been verified in other studies. The present article describes the most current data on this topic, and it also highlights the need formoremulticentric and randomized trials to determine the correct cut-off points that represent the high sensibility and specificity of the method.

Magnetic Resonance Evaluation of Normal Optic Nerve Sheath and Optic Nerve Diameter in Eastern Indian Paediatric Population- A Retrospective Study

Background: Prospective magnetic resonance imaging (MRI) of orbits in healthy paediatric population is difficult as it involves sedation or general anaesthesia in most of the cases. The data of normal value of healthy paediatric optic nerve and optic nerve sheath diameter is also scant in literatures for Indian paediatric population. The normal data will help in defining abnormal optic nerve such as congenital optic nerve hypoplasia, optic nerve atrophy and distended optic nerve sheath in raised intracranial pressure. AIM: The aim of our retrospective study is to define the normal value of optic nerve and optic nerve sheath diameter in MRI of paediatric Indian population. MATERIAL AND METHODS:190 MRI studies of paediatric brain with normal radiology reports and no history of raised intracranial pressure were retrospectively reviewed by two senior radiologists using T2 weighted axial brain images. RESULT: The mean optic sheath diameter and optic nerve diameter of 380 eye balls were 4.746 and 2.59 mm respectively. The age wise distribution of optic sheath diameter and optic nerve diameter were 4.08±0.019, 2.05±0.608 in 0-2-year age group, 4.83±0.575, 2.54±0.456 in 3-6-year age group, 4.789±0.553, 2.704±0.447 in 7-12-year age group, and 4.82±0.567, 2.65±0.412 in 13-18 years age group in mean (mm)±standard deviations respectively. Three hundred seventy-one (97%) optic sheath measurement of the 380 eye balls was below the threshold of 6 mm and about 352 (92%) optic nerve measurements out of 380 globes were having optic nerve thickness above 2 mm. This normative data will help the ophthalmologist, clinician, neuro-ophthalmologist and radiologists for better quantitative evaluation of pediatric patient with vision abnormality.

Role of ultrasonographic optic nerve sheath diameter in the diagnosis and follow-up of papilledema and its correlation with Frisén's severity grading

Purpose: The aim of this study was to compare the ultrasonographic optic nerve sheath diameter (ONSD) in different grades of papilledema and in controls and to evaluate ONSD in atrophic papilledema/optic atrophy when raised ICP was suspected. Methods: Prospective cross-sectional case–control study. Following an ocular examination, papilledema was graded clinically using modified Frisén's grading. An ultrasonographic cross section of the retrobulbar optic nerve was obtained with a posterior transverse scan. Independent t-test and analysis of variance were the statistical tools used in the study. Results: The study included 55 cases and 55 age- and gender-matched controls; mean (± standard deviation) age was 37.17 (±11.25) years and male: female ratio was 49:61. There was a statistically significant difference in the mean ultrasonographic ONSD between cases [4.89 (±0.65) mm] and controls [3.12 (±0.22) mm] (P < 0.001). There was a significant difference in the mean ONSD across Frisén's grades of papilledema (P < 0.001). The mean ONSD in atrophic papilledema was 6.2 (±0.75) mm. Conclusion: In the presence of symptoms, ultrasonographic ONSD >4 mm is diagnostic of papilledema. Ultrasonographic ONSD correlates well with the severity of papilledema and can be used to follow-up patients with chronically elevated ICP. It is useful in detecting raised ICP in the presence of optic atrophy and to distinguish true papilledema from pseudopapilledema.

Ultrasonographic Evaluation of the Optic Nerve Sheath in the Diagnosis of Idiopathic Intracranial Hypertension

Intracranial hypertension (ICH) is a life-threatening condition that can be observed in several diseases. Its clinical presentation is variable, with headache, nausea, vomiting, visual disturbances, papilledema, and alterations in the level of consciousness. The gold standard for the diagnosis of ICHis still the intracranial implantation of invasive devices. Non-invasive techniques, such as ultrasonography of the optic nerve sheath (USONS), have emerged in recent years with promising clinical results. The authors report the case of a patient with progressive headache associated with visual impairment and papilledema, and the eventual diagnosis of idiopathic intracranial hypertension using USONS.