Albert Angelique F, Kirkman Matthew A
Great Ormond Street Hospital, London, UK.
Department of Neurosurgery, The Royal London Hospital, Barts Heath NHS Trust, London, UK; The National Hospital for Neurology and Neurosurgery, University College London Hospitals, Queen Square, London, UK.
J Stroke Cerebrovasc Dis. 2017 Nov;26(11):2671-2679. doi: 10.1016/j.jstrokecerebrovasdis.2017.06.041. Epub 2017 Jul 20.
Optic nerve sheath diameter (ONSD) can predict intracranial hypertension and outcomes in severe traumatic brain injury. Its utility in middle cerebral artery (MCA) stroke is unknown.
We reviewed serial radiological measurements, including ONSD, in patients with MCA stroke undergoing decompressive craniectomy (DC) for malignant MCA syndrome and compared demographic, clinical, and radiological data with an age- and gender-matched group of nonmalignant MCA stroke patients.
Patients admitted to a large tertiary hospital in London, UK, between April 2012 and October 2016 with MCA infarction were identified through 2 data sources. We quantified ONSD, eyeball transverse diameter (ETD), ONSD/ETD ratio, midline shift (MLS), and infarct volume on computed tomography (CT).
We identified 19 patients (mean age = 49.8 years [standard deviation = 12.5]) with malignant MCA stroke and 19 patients (47.8 years [16.0]) with nonmalignant MCA stroke. Mean ONSD, ONSD/ETD ratio, MLS, and infarct volume on initial CT all significantly increased after developing malignant MCA syndrome and decreased (except infarct volume, which increased) following DC (all Ps <.05). ONSD and ONSD/ETD ratios in the malignant group did not correlate with functional outcomes but were significantly higher on initial CT compared with the nonmalignant group (mean ONSD: 5.66 mm [.6] versus 4.97 mm [.5], P = .001; mean ONSD/ETD ratio: .25 [.03] versus .22 [.02], P = .002).
ONSD, ONSD/ETD ratio, MLS, and infarct volume change dynamically in patients with malignant MCA infarction who undergo DC. An ONSD of more than 5.25 mm and an ONSD/ETD ratio of more than .232 on initial CT may identify MCA stroke patients at high risk of developing malignant MCA syndrome.
视神经鞘直径（ONSD）可预测重型创伤性脑损伤患者的颅内高压及预后。其在大脑中动脉（MCA）卒中中的作用尚不清楚。
我们回顾了因恶性MCA综合征接受减压颅骨切除术（DC）的MCA卒中患者的系列影像学测量结果，包括ONSD，并将人口统计学、临床和影像学数据与年龄及性别匹配的非恶性MCA卒中患者组进行比较。
通过两个数据源确定了2012年4月至2016年10月期间入住英国伦敦一家大型三级医院的MCA梗死患者。我们在计算机断层扫描（CT）上对ONSD、眼球横径（ETD）、ONSD/ETD比值、中线移位（MLS）和梗死体积进行了量化。
我们确定了19例（平均年龄=49.8岁[标准差=12.5]）恶性MCA卒中患者和19例（47.8岁[16.0]）非恶性MCA卒中患者。在发生恶性MCA综合征后，初始CT上的平均ONSD、ONSD/ETD比值、MLS和梗死体积均显著增加，而在DC后降低（梗死体积除外，其增加）（所有P<.05）。恶性组的ONSD和ONSD/ETD比值与功能预后无关，但与非恶性组相比，初始CT上显著更高（平均ONSD：5.66 mm[.6]对4.97 mm[.5]，P=.001；平均ONSD/ETD比值：.25[.03]对.22[.02]，P=.002）。
接受DC的恶性MCA梗死患者的ONSD、ONSD/ETD比值、MLS和梗死体积会动态变化。初始CT上ONSD大于5.25 mm且ONSD/ETD比值大于.232可能识别出发生恶性MCA综合征风险较高 的MCA卒中患者。
