Prognostic role of optic nerve sheath diameter in stroke in emergency department, a case control study

Abstract

Background: Sonographic measurement of optic nerve sheath diameter (ONSD) can reflect intracranial pressure (ICP) indirectly and determine the neurology intensive care unit (NICU) requirement and mortality in acute ischemic stroke (AIS). Aim: To demonstrate the effectiveness of ONSD to determine mortality, morbidity, and NICU requirement on patients with the AIS. Methods: The sonographic ONSD measurements were performed on each patient with AIS, over 18 years old. All patients were categorized according to the Oxfordshire Community Stroke Project (OCSP) classification system. MRI images were examined for increased ICP, and the patients were categorized into two groups as increased ICP (i‑ICP) and normal ICP. The ONSD results were evaluated in terms of classifications, outcomes, and prognosis of the patients. Results: One hundred and five patients were included and 31 (35.2%) were in the i‑ICP group. The median ONSDs were 5.26 mm in the i‑ICP group and 4.62 mm in the normal ICP group (P < 0.001). The median ONSDs were 5.13 mm in the NICU group and 4.69 mm in the neurology ward (NW) group (P = 0.001). The total anterior circulation infarction (TACI) subgroup had higher ONSDs than the others (TACI: 5.27 mm; PACI: 4.73 mm; POCI: 4.77 mm; and LACI: 4.64 mm, P < 0.001). The NICU requirements were higher in the TACI subgroup. The median ONSD was 5.42 mm in the deceased group (survived: 4.77 mm, P < 0.001). Conclusion: ONSD may be favorable for predicting the increased ICP and the NICU requirement in OCSP subgroups. Moreover, ONSD can be used to foresee the mortality of AIS.