The Use of POCUS-Obtained Optic Nerve Sheath Diameter in Intracerebral Hemorrhage
Background: Intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. ICH causes increased intracranial pressure (ICP), leading to brain herniation as the disease progresses. Neurological physical exam and monitoring of the disease progression can be challenging due to the imp...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
CINQUILL Medical Publishers Inc.
2023-11-01
|
| Series: | POCUS Journal |
| Subjects: | |
| Online Access: | https://ojs.library.queensu.ca/index.php/pocus/article/view/16563 |
| _version_ | 1827631012969971712 |
|---|---|
| author | Alireza Nathani Shekhar A. Ghamande Sarita Kambhampati Braden Anderson Matthew Lohse Heath D. White |
| author_facet | Alireza Nathani Shekhar A. Ghamande Sarita Kambhampati Braden Anderson Matthew Lohse Heath D. White |
| author_sort | Alireza Nathani |
| collection | DOAJ |
| description |
Background: Intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. ICH causes increased intracranial pressure (ICP), leading to brain herniation as the disease progresses. Neurological physical exam and monitoring of the disease progression can be challenging due to the impaired consciousness and routine clinical management in this patient population. Given the continuity of the intracranial cavity with the optic nerve subarachnoid space, an increased ICH leads to distension of the optic nerve sheath. We herein examined the correlation between the ICH volume and the optic nerve sheath diameter (ONSD) measured by point of care ultrasound (POCUS). Methods: Patients with ICH diagnosed with a head computed tomography (CT) scan were prospectively enrolled in this study. A portable ultrasound was used to measure the (ONSD); the volume of ICH hematoma, the Acute Physiology And Chronic Health Evaluation IV score, and the Intracerebral Hemorrhage score were collected. A Spearman rank correlation coefficient test was used to assess the relationship between continuous variables. A Wilcoxon rank sum test was used to assess differences in continuous variables between two groups. A p-value less than 0.05 was deemed as statistically significant. Results: A total of 28 subjects were enrolled. A moderate positive correlation was detected between hemorrhage volume and the average ONSD (correlation = 0.4214, p = 0.0255). A weak positive correlation was detected between average ONSD and APACHE IV (correlation = 0.2347, p = 0.2294). A weak moderate positive correlation was detected between average ONSD and ICH score (correlation = 0.1160, p = 0.5566). Conclusions: In this study we demonstrate that ONSD is moderately correlated with hematoma size. A potential application may include serial measurements of the ONSD with ultrasound. This may offer a quick, non-invasive technique that can be used in an intracerebral hemorrhage to monitor the stability or expansion of a hematoma indirectly, and potentially catch a catastrophic event like cerebral herniation.
|
| first_indexed | 2024-03-09T14:15:04Z |
| format | Article |
| id | doaj.art-c53cb2727b3f40a8b980df4a6c68fc94 |
| institution | Directory Open Access Journal |
| issn | 2369-8543 |
| language | English |
| last_indexed | 2024-03-09T14:15:04Z |
| publishDate | 2023-11-01 |
| publisher | CINQUILL Medical Publishers Inc. |
| record_format | Article |
| series | POCUS Journal |
| spelling | doaj.art-c53cb2727b3f40a8b980df4a6c68fc942023-11-29T05:00:06ZengCINQUILL Medical Publishers Inc.POCUS Journal2369-85432023-11-018210.24908/pocus.v8i2.16563The Use of POCUS-Obtained Optic Nerve Sheath Diameter in Intracerebral HemorrhageAlireza Nathani0https://orcid.org/0000-0002-5641-7249Shekhar A. Ghamande1Sarita Kambhampatihttps://orcid.org/0009-0009-9483-8886Braden Andersonhttps://orcid.org/0000-0003-4359-0429Matthew Lohsehttps://orcid.org/0000-0002-4535-7770Heath D. Whitehttps://orcid.org/0000-0003-1065-3681University of MinnesotaBaylor Scott and White Medical Center Background: Intracerebral hemorrhage (ICH) is associated with high morbidity and mortality. ICH causes increased intracranial pressure (ICP), leading to brain herniation as the disease progresses. Neurological physical exam and monitoring of the disease progression can be challenging due to the impaired consciousness and routine clinical management in this patient population. Given the continuity of the intracranial cavity with the optic nerve subarachnoid space, an increased ICH leads to distension of the optic nerve sheath. We herein examined the correlation between the ICH volume and the optic nerve sheath diameter (ONSD) measured by point of care ultrasound (POCUS). Methods: Patients with ICH diagnosed with a head computed tomography (CT) scan were prospectively enrolled in this study. A portable ultrasound was used to measure the (ONSD); the volume of ICH hematoma, the Acute Physiology And Chronic Health Evaluation IV score, and the Intracerebral Hemorrhage score were collected. A Spearman rank correlation coefficient test was used to assess the relationship between continuous variables. A Wilcoxon rank sum test was used to assess differences in continuous variables between two groups. A p-value less than 0.05 was deemed as statistically significant. Results: A total of 28 subjects were enrolled. A moderate positive correlation was detected between hemorrhage volume and the average ONSD (correlation = 0.4214, p = 0.0255). A weak positive correlation was detected between average ONSD and APACHE IV (correlation = 0.2347, p = 0.2294). A weak moderate positive correlation was detected between average ONSD and ICH score (correlation = 0.1160, p = 0.5566). Conclusions: In this study we demonstrate that ONSD is moderately correlated with hematoma size. A potential application may include serial measurements of the ONSD with ultrasound. This may offer a quick, non-invasive technique that can be used in an intracerebral hemorrhage to monitor the stability or expansion of a hematoma indirectly, and potentially catch a catastrophic event like cerebral herniation. https://ojs.library.queensu.ca/index.php/pocus/article/view/16563Intracranial HemorrhageOptic nerve sheath diameterocular ultrasound |
| spellingShingle | Alireza Nathani Shekhar A. Ghamande Sarita Kambhampati Braden Anderson Matthew Lohse Heath D. White The Use of POCUS-Obtained Optic Nerve Sheath Diameter in Intracerebral Hemorrhage POCUS Journal Intracranial Hemorrhage Optic nerve sheath diameter ocular ultrasound |
| title | The Use of POCUS-Obtained Optic Nerve Sheath Diameter in Intracerebral Hemorrhage |
| title_full | The Use of POCUS-Obtained Optic Nerve Sheath Diameter in Intracerebral Hemorrhage |
| title_fullStr | The Use of POCUS-Obtained Optic Nerve Sheath Diameter in Intracerebral Hemorrhage |
| title_full_unstemmed | The Use of POCUS-Obtained Optic Nerve Sheath Diameter in Intracerebral Hemorrhage |
| title_short | The Use of POCUS-Obtained Optic Nerve Sheath Diameter in Intracerebral Hemorrhage |
| title_sort | use of pocus obtained optic nerve sheath diameter in intracerebral hemorrhage |
| topic | Intracranial Hemorrhage Optic nerve sheath diameter ocular ultrasound |
| url | https://ojs.library.queensu.ca/index.php/pocus/article/view/16563 |
| work_keys_str_mv | AT alirezanathani theuseofpocusobtainedopticnervesheathdiameterinintracerebralhemorrhage AT shekharaghamande theuseofpocusobtainedopticnervesheathdiameterinintracerebralhemorrhage AT saritakambhampati theuseofpocusobtainedopticnervesheathdiameterinintracerebralhemorrhage AT bradenanderson theuseofpocusobtainedopticnervesheathdiameterinintracerebralhemorrhage AT matthewlohse theuseofpocusobtainedopticnervesheathdiameterinintracerebralhemorrhage AT heathdwhite theuseofpocusobtainedopticnervesheathdiameterinintracerebralhemorrhage AT alirezanathani useofpocusobtainedopticnervesheathdiameterinintracerebralhemorrhage AT shekharaghamande useofpocusobtainedopticnervesheathdiameterinintracerebralhemorrhage AT saritakambhampati useofpocusobtainedopticnervesheathdiameterinintracerebralhemorrhage AT bradenanderson useofpocusobtainedopticnervesheathdiameterinintracerebralhemorrhage AT matthewlohse useofpocusobtainedopticnervesheathdiameterinintracerebralhemorrhage AT heathdwhite useofpocusobtainedopticnervesheathdiameterinintracerebralhemorrhage |