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Can Optic Nerve Sheath Diameter Diagnose Raised Intracranial Pressure Before Neuroimaging Results in Cerebrovascular Accidents?

Manikanta Chaitanya L , BS Gopala Krishna1 , Manikanta Chaitanya L2 , K Raghu3 , Ahammad Basha SK4 , Pranay Krishna5 , Ravi Sankar6 , Dhiran Showri B7

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Indian Journal of Emergency Medicine 6(1):p 23-29, January-March 2020. | DOI: http://dx.doi.org/10.21088/ijem.2395.311X.6120.4

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BS Gopala Krishna, Manikanta Chaitanya L, K Raghu, et al. Can Optic Nerve Sheath Diameter Diagnose Raised Intracranial Pressure Before Neuroimaging Results in Cerebrovascular Accidents? Indian J Emerg Med. 2020;6(1):23–29.

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Abstract

Introduction: Stroke is the primary cause of morbidity and mortality in India. Stroke management depends on neuroimaging and time management in the emergency department. The main aim of the present study is to determine whether Optic Nerve Sheath Diameter (ONSD) could be an early predictor of raised Intracranial Pressure (ICP) before neuroimaging results. Methodology: Computed Tomography (CT) scan was considered to be positive for raised ICP if the findings as cerebral edema, midline shift, mass effect, the collapse of ventricles, and compression of cisterns were present. Modified Rankin Score (mRS), Glasgow Coma Scale (GCS) and National Institute of Health Stroke Scale (NIHSS) were recorded. Results: A total of 66 patients were included with the Mean ± SD age of 62.62 ± 12.29 [Range: 35–85] years. The mean binocular ONSD was significantly higher in raised ICP than without raised ICP on CT imaging (p < 0.0001). The mean of mRS and NIHSS were significantly higher in raised ONSD than normal ONSD (p < 0.0001). The mean binocular ONSD was significantly higher with ventilator support than without ventilator support (p < 0.0001). The mean binocular ONSD had a very strong positive correlation with NIHSS (r = 0.781, p < 0.0001) and a very strong negative correlation with GCS (r = –0.751, p < 0.0001). It was also observed that there was a very strong negative correlation between NIHSS and GCS (r = –0.898, p < 0.0001). The Area Under Curve (AUC) showed that mean ONSD had the highest sensitivity level (100%) than NIHSS (95.83%) and mRS (79.71%) for raised ICP (p < 0.0001). Conclusion: ONSD can be used in the early diagnosis and management of cerebrovascular accident cases and it could be an early indicator of raised Intracranial Pressure (ICP) before neuroimaging results. 

Keywords: Optic nerve sheath diameter; Intracranial pressure; Glasgow Coma Scale; National institute of health stroke scale score; Modified Rankin Score; Computed tomography.

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BS Gopala Krishna, Manikanta Chaitanya L, K Raghu, et al. Can Optic Nerve Sheath Diameter Diagnose Raised Intracranial Pressure Before Neuroimaging Results in Cerebrovascular Accidents? Indian J Emerg Med. 2020;6(1):23–29.

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DOI: http://dx.doi.org/10.21088/ijem.2395.311X.6120.4

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