Department of Neurointensive Care, Kayseri City Hospital, Kayseri, Turkey.
Department of Emergency Medicine, Kayseri City Hospital, Kayseri, Turkey.
J Stroke Cerebrovasc Dis. 2021 Feb;30(2):105523. doi: 10.1016/j.jstrokecerebrovasdis.2020.105523. Epub 2020 Dec 9.
Measurement of the optic nerve sheath diameter (ONSD) with ultrasound enables non-invasive and indirect assessment of increased intracranial pressure (ICP). Although most of the studies were employed with traumatic brain injury patients, it's increasingly popular in acute ischemic stroke (AIS) studies.
Evaluating whether using ONSD as a follow-up measurement would help monitor the thrombolytic therapy (TT) effectiveness and determine the high-risk patients for malignant middle cerebral artery (MCA) syndrome.
This prospective observational study was conducted between August 1, 2019, and February 1, 2020, in a tertiary hospital. Forty-four patients were eligible. We determined the TT moment as the time when the first ocular ultrasound measurement would be made (time 0). Also, we decided on the 24 h after the treatment as the time to perform the second ocular ultrasound measurement (time 24). The National Institute of Health Stroke Scale (NIHSS), the Glasgow Coma Scale (GCS), and the Alberta Stroke Program Early Computed Tomography (ASPECT) scores were evaluated blindly at the time-0 and the time-24. The cut-off value of ONSD was 0.55 mm.
There was no difference in ONSD results before and after the TT (p = 0.414). But, patients with an equal or higher value than cut-off had an increased risk for complications such as malignant-MCA, bleeding, seizure, etc. (p = 0.05). Malignant-MCA was observed in four patients with higher ONSD values. At the time-24, NIHSS decreased, GCS and ASPECT scores increased. Finally, ONSD was positively correlated with the NIHSS and negatively correlated with the GCS at the time-24.
Monitoring ONSD values in both the emergency department and the intensive care unit may be useful in the early diagnosis of MCA stroke complications and the follow-up of TT's effectiveness.
视神经鞘直径（ONSD）的超声测量可实现对颅内压（ICP）升高的非侵入性和间接评估。尽管大多数研究都应用于创伤性脑损伤患者，但它在急性缺血性脑卒中（AIS）研究中越来越受欢迎。
评估将 ONSD 作为随访测量是否有助于监测溶栓治疗（TT）的效果，并确定恶性大脑中动脉（MCA）综合征的高危患者。
这项前瞻性观察研究于 2019 年 8 月 1 日至 2020 年 2 月 1 日在一家三级医院进行。共 44 名患者符合条件。我们将 TT 时间定义为进行第一次眼部超声测量的时间（时间 0）。此外，我们决定在治疗后 24 小时进行第二次眼部超声测量（时间 24）。在时间 0 和时间 24 进行国立卫生研究院卒中量表（NIHSS）、格拉斯哥昏迷量表（GCS）和阿尔伯塔卒中项目早期计算机断层扫描（ASPECT）评分的盲法评估。ONSD 的截断值为 0.55mm。
TT 前后 ONSD 结果无差异（p=0.414）。但是，等于或高于截断值的患者发生恶性 MCA、出血、癫痫等并发症的风险增加（p=0.05）。4 名 ONSD 值较高的患者出现恶性 MCA。在时间 24，NIHSS 降低，GCS 和 ASPECT 评分增加。最后，ONSD 在时间 24 与 NIHSS 呈正相关，与 GCS 呈负相关。
在急诊科和重症监护病房监测 ONSD 值可能有助于早期诊断 MCA 卒中并发症和随访 TT 的效果。
