J Korean Soc Emerg Med.  2016 Oct;27(5):473-481. 10.0000/jksem.2016.27.5.473.

The Utility of the Optic Nerve Sheath Diameter in Predicting Post-Thrombolysis Intracranial Hemorrhage

• Jeon GH
• Kim YW
• Yoon YS
• Kim TH
• Park DH

• KMID: 2358289
• DOI: http://doi.org/10.0000/jksem.2016.27.5.473

Abstract

PURPOSE
We tried to identify the factors associated with intracranial hemorrhage (ICH) in patients with acute brain infarction receiving a tissue plasminogen activator. We assumed that ICH is increased if intracranial pressure has been increased in brain infarction patients who underwent IV thrombolysis. In this study, we selected the optic nerve sheath diameter (ONSD) in a way that intracranial pressure (ICP) measurement. ONSD measurements were compared with the occurrence of brain hemorrhage.
METHODS
This study was a retrospective analysis of data acquired between January 2013 and December 2015. We included 100 acute brain infarction patients who received brain MRI and underwent IV thrombolysis in the emergency department. The ONSD measurements were taken with MRI in the axial view and compared with the occurrence of brain hemorrhage. The factors contributing to ICH in patients with thrombolysis was analyzed by a binary logistic regression analysis. Receiver operating characteristic (ROC) curves were used to find the cut-off value of ONSD that maximized the sum of the sensitivity and specificity. Statistical analysis was performed using SPSS 20.0.
RESULTS
The mean ONSD for patients without ICH was 5.50±0.57 mm, and for those with ICH was 5.97±0.54 mm. ONSD in the ICH group were significantly larger than in the non-ICH group (5.50±0.57 versus 5.97±0.54).
CONCLUSION
ONSD in acute brain infarction patients who underwent IV thrombolysis is useful in the assessment of ICH risk.

Keyword

Brain infarction; Intracranial hemorrhage; Intracranial pressure; Optic nerve; Tissue plasminogen activator

MeSH Terms

Brain
Brain Infarction
Emergency Service, Hospital
Humans
Intracranial Hemorrhages*
Intracranial Pressure
Logistic Models
Magnetic Resonance Imaging
Optic Nerve*
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Tissue Plasminogen Activator
Tissue Plasminogen Activator