J Neurointensive Care.  2018 Oct;1(1):25-31. 10.32587/jnic.2018.00031.

The Prognostic Value of Optic Nerve Sheath Diameter in Patients with Poor-Grade Subarachnoid Hemorrhages

• Ju DG
• Ryu JA
• Kim YO
• Lee S
• Baek JS

• KMID: 2555416
• DOI: http://doi.org/10.32587/jnic.2018.00031

Abstract

Objective
: We evaluated if the optic nerve sheath diameter (ONSD) on brain computed tomography (CT) could be used to predict neurological outcomes of patients with poor-grade subarachnoid hemorrhage (SAH).
Methods
: This was a retrospective and observational study of adult patients with poor-grade SAH admitted January 2012 through June 2017. Initial brain CT was performed within 12 hours from onset of SAH. Follow-up brain CT was performed within 48 hours from onset of SAH and after aneurysmal treatment. The primary outcome was neurological status upon six months later assessed with Glasgow Outcome Scale (GOS, 1 to 5).
Results
: Among 59 patients with poor-grade SAH, survival to discharge was identified in 47 (79.7%) patients. Of these 47 survivors, 39 (66.1%) had good neurological outcomes (GOS of 3, 4 or 5). In this study, initial ONSDs and follow-up ONSDs in the poor neurological outcome group were significantly greater than those in the good neurological outcome group (all p<0.03). The intracranial pressure (ICP) was monitored in only 13 (22.0%) patients at that time of follow-CT scanning. Using simple correlation analysis, there was a linear correlation between ONSD and ICP (ρ=0.683, p=0.010). In ROC curve analysis for prediction of poor neurological outcome, ONSDs and ONSD indices had considerable predictive values (C-statistics: 0.683 to 0.804) and similar predictive performances for poor neurological outcome.
Conclusions
: The ONSDs and ONSD indices measured on CT scanning may be beneficial for predicting neurological outcomes in patients with poor-grade SAH.

Keyword

Optic nerve sheath diameter; Brain computed tomography; Subarachnoid hemorrhage