Optic nerve sheath diameter change in prediction of malignant cerebral edema in ischemic stroke: an observational study.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968555 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2377 (Electronic) Linking ISSN: 14712377 NLM ISO Abbreviation: BMC Neurol Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

Brain Edema/*etiology ; Optic Nerve/*pathology ; Stroke/*pathology; Brain Edema/pathology ; Brain Edema/surgery ; Craniotomy ; Decompression, Surgical ; Disease Progression ; Female ; Humans ; Male ; Middle Aged ; Optic Nerve/diagnostic imaging ; Patient Selection ; Retrospective Studies ; Stroke/complications ; Stroke/surgery ; Tomography, X-Ray Computed/methods

Background: In acute large anterior circulation infarct patients with large core volume, we evaluated the role of optic nerve sheath diameter (ONSD) change rates in prediction of malignant progression.
Methods: We performed a retrospective observational study including patients with anterior circulation acute ischemic stroke with large ischemic cores from January 2010 to October 2017. Primary outcome was defined as undergoing decompressive surgery or death due to severe cerebral edema, and termed malignant progression. Patients were divided into malignant progressors and nonprogressors. Malignant progression was divided into early progression that occurred before D1 CT, and late progression that occurred afterwards. Retrospective analysis of changes in mean ONSD/eyeball transverse diameter (ETD) ratio, and midline shifting (MLS) were evaluated on serial computed tomography (CT). Through analysis of CT at baseline, postprocedure, and at D1, the predictive ability of time based change in ONSD/ETD ratio in predicting malignant progression was evaluated.
Results: A total of 58 patients were included. Nineteen (32.8%) were classified as malignant; 12 early, and 7 late progressions. In analysis of CT postprocedure , A 1 mm/hr. rate of change in MLS during the CT baseline -CT postprocedure time phase lead to a 6.7 fold increased odds of early malignant progression (p < 0.05). For ONSD/ETD, 1%/hr. change lead to a 1.6 fold increased odds, but this association was trending (p = 0.249). In the CT D1 , 1%/day change of ONSD/ETD in the CT baseline -CT D1 time phase lead to a 1.4 fold increased odds of late malignant progression (p = 0.021) while 1 mm/day rate of change in MLS lead to a 1.5 fold increased odds (p = 0.014).
Conclusions: The rate of ONSD/ETD changes compared to baseline at D1 CT can be a predictor of late malignant progression along with MLS. ONSD/ETD change rates evaluated at postprocedure did not predict early malignant progression.

J Neurosurg. 1989 Oct;71(4):498-502. (PMID: 2795168)
Biol Neonate. 2003;84(3):202-5. (PMID: 14504443)
Crit Care. 2013 Mar 27;17(2):R61. (PMID: 23536993)
Surg Radiol Anat. 1996;18(4):323-8. (PMID: 8983112)
Neurology. 2011 Feb 15;76(7 Suppl 2):S50-6. (PMID: 21321352)
Neurology. 1996 Aug;47(2):393-8. (PMID: 8757010)
Lancet Neurol. 2009 Apr;8(4):326-33. (PMID: 19269254)
J Stroke. 2014 Sep;16(3):146-60. (PMID: 25328873)
Lancet Neurol. 2007 Mar;6(3):215-22. (PMID: 17303527)
J Neurotrauma. 2000 Jun-Jul;17(6-7):597-627. (PMID: 10937906)
Br J Ophthalmol. 2003 Jun;87(6):777-81. (PMID: 12770980)
Am J Emerg Med. 2017 Nov;35(11):1607-1611. (PMID: 28473274)
Lancet Neurol. 2007 Jul;6(7):580; author reply 580-1. (PMID: 17582356)
Am J Ophthalmol. 1993 Nov 15;116(5):548-56. (PMID: 8238213)
Am J Emerg Med. 2018 Nov;36(11):2064-2067. (PMID: 30135026)
J Neurotrauma. 2007;24 Suppl 1:S55-8. (PMID: 17511546)
Stroke. 2014 Jan;45(1):134-40. (PMID: 24203846)
Head Face Med. 2014 Aug 17;10:32. (PMID: 25130267)
Stroke. 1999 Feb;30(2):287-92. (PMID: 9933261)
J Stroke Cerebrovasc Dis. 1999 May-Jun;8(3):183-91. (PMID: 17895162)
J Neurosurg. 1997 Jul;87(1):34-40. (PMID: 9202262)
JAMA Ophthalmol. 2018 Mar 1;136(3):250-256. (PMID: 29392301)
Ann Neurol. 2010 Oct;68(4):435-45. (PMID: 20865766)
Stroke. 1999 Nov;30(11):2280-4. (PMID: 10548658)
Intensive Care Med. 2014 Sep;40(9):1267-74. (PMID: 25034476)
J Neurosurg. 2010 Mar;112(3):648-57. (PMID: 19663552)
Crit Care. 2019 Feb 26;23(1):65. (PMID: 30808383)
J Surg Res. 2011 Oct;170(2):265-71. (PMID: 21550065)
J Appl Clin Med Phys. 2017 Jan;18(1):251-259. (PMID: 28291920)
J Stroke. 2016 May;18(2):179-86. (PMID: 26915505)
Stroke. 2007 Sep;38(9):2506-17. (PMID: 17690311)
Transl Stroke Res. 2018 Dec;9(6):600-607. (PMID: 29508233)
Acta Neurochir (Wien). 2015 Jan;157(1):109-13. (PMID: 25307778)
Anesth Analg. 2008 Jan;106(1):240-8. (PMID: 18165584)
J Neurotrauma. 2007;24 Suppl 1:S45-54. (PMID: 17511545)
Neurochirurgia (Stuttg). 1987 Mar;30(2):53-5. (PMID: 3574583)
N Engl J Med. 1986 Apr 10;314(15):953-8. (PMID: 3960059)
N Engl J Med. 2014 Mar 20;370(12):1091-100. (PMID: 24645942)
J Stroke Cerebrovasc Dis. 2017 Nov;26(11):2671-2679. (PMID: 28736129)

Keywords: Brain edema; Cerebral infarction; Intracranial pressure; Optic nerve; Ultrasonography

Date Created: 20200923 Date Completed: 20201123 Latest Revision: 20201123

20250114

PMC7510108

10.1186/s12883-020-01931-w

32962645