scholarly journals Optic nerve sheath diameter on computed tomography not predictive of neurological status post-cardiac arrest

CJEM ◽  
2016 ◽  
Vol 19 (3) ◽  
pp. 181-185 ◽  
Author(s):  
Barret Rush ◽  
Andrew Wormsbecker ◽  
Landon Berger ◽  
Katie Wiskar ◽  
Mypinder S. Sekhon ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiac Arrest ◽  
Optic Nerve ◽  
Neurological Outcome ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Good Outcome ◽  
Nerve Sheath ◽  
Outcome Group ◽  
Poor Neurological Outcome

AbstractObjectiveOptic nerve sheath diameter (ONSD) measured on a head computed tomography (CT) has been suggested as a potential prognostic factor for poor neurological outcome after cardiac arrest. We performed a single centre retrospective cohort analysis to further investigate this relationship.MethodsAll patients >18 years of age admitted to St. Paul’s Hospital in Vancouver, Canada who survived a cardiac arrest and had a CT scan of the head within 48 hours were included in the analysis.ResultsA total of 72 patients met inclusion criteria for the study; 54 (75.0%) of the patients had a poor neurological outcome, whereas 18 (25.0%) patients were discharged from the hospital with a good outcome. A CT head was obtained for patients in the good outcome group in a mean time of 9.3 hours (SD 10.0) compared to 10.2 hours (SD 11.2) for the poor outcome group (p=0.75). There was no difference in average ONSD observed between the two outcome groups (6.66 mm SD 0.78 v. 6.60 mm SD 0.82, p=0.77). Multiple logistic regression failed to show any association between ONSD and neurological outcome when adjusted for all other covariates (OR 1.32 95% CI 0.40-4.34, p=0.65). Setting an ONSD threshold of >8 mm (OR 2.32, 95% CI 0.14-39.40, p=0.55) or >7 mm (OR 0.28, 95% CI 0.03-2.77, p=0.28) also failed to show any association on neurological outcome.ConclusionThere was no observed difference in ONSD between those with a good neurological outcome and those with a poor outcome. ONSD was not an independent predictor of poor neurological outcome.

Abstract 334: Point-Of-Care Ultrasound in the Assessment of Optic Nerve Sheath Diameter After Out-Of-Hospital Cardiac Arrest

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Pavitra Kotini-Shah ◽  
Sarah E Kim ◽  
Richard Gordon ◽  
Benjamin Karfunkle ◽  
Pratik B Doshi ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Optic Nerve ◽  
Neurological Outcome ◽  
Optic Nerve Sheath Diameter ◽  
Small Sample ◽  
Optic Nerve Sheath ◽  
Point Of Care Ultrasound ◽  
Nerve Sheath ◽  
Ocular Ultrasound ◽  
Linear Probe

Introduction: Hypoxic-ischemic injury from cardiac arrest may cause cerebral edema, leading to increased intracranial pressure (ICP) and brain tissue damage. Optic nerve sheath diameter (ONSD) is associated with elevated ICP. Limited clinical studies have reported ONSD changes in the early post-resuscitation time frame. We sought to evaluate the utility of bedside ocular ultrasound measurements in the assessment of post-cardiac arrest brain injury. Methods: We studied adult out-of-hospital cardiac arrests treated at an urban academic ED and achieving return of spontaneous circulation (ROSC) between May 2018 to May 2019. We included witnessed and unwitnessed arrest as well as shockable and non-shockable rhythms. After ROSC, trained emergency physicians performed bedside ultrasonographic assessment of bilateral ONSD at 1, 6, 24, 48, and 72 hours using an ocular preset on a 15MHz linear probe. ONSD measurements at these time frames were compared between groups stratified by rhythm type and neurological outcome. Cerebral performance category (CPC) was measured at 72 hours and at discharge. Results: Out of 48 eligible patients, 15 were excluded from the study due to lack of consent or available ultrasound images. We included 33 patients, of which 11 were female and 22 were male, with a median age of 57 (IQR 20). There were 19 with an initial rhythm of asystole or pulseless electrical activity (PEA), 9 with ventricular fibrillation arrests, and 5 with an unclear rhythm. At 1 hour, patients with CPC 1-2 had smaller ONSD compared to patients with CPC 3-5 (5.5mm vs 6.1mm, p=0.03). At 72 hour, patients with CPC score of 1-2 had an average reduction in ONSD of 1.6mm verses 0.29mm increase in patients with CPC 3-5. Despite small sample size, a trend towards higher ONSD were seen in patients with non-shockable vs shockable rhythm. Females were also consistently found to have smaller ONSD measurements in all time periods compared to males. Conclusions: This is the first study in the USA to perform analysis using ONSD measurements in cardiac arrest patients. Preliminary analysis of this on-going pilot revealed a greater improvement in ONSD diameters in patients with a favorable neurological outcome. OSND may have utility in prognostication of the post-arrest state.

scholarly journals Optic nerve sheath diameter as a predictor of acute cerebellar infarction in acute vertigo patients without brain computed tomography abnormalities

2019 ◽  
Vol 27 (3) ◽  
pp. 168-175
Author(s):  
Myoung Sun You ◽  
Sun Hwa Lee ◽  
Seong Jong Yun ◽  
Seokyong Ryu ◽  
Seung Woon Choi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Optic Nerve ◽  
Confidence Interval ◽  
Operating Characteristic ◽  
Optic Nerve Sheath Diameter ◽  
Optic Nerve Sheath ◽  
Cerebellar Infarction ◽  
Resonance Imaging ◽  
Acute Infarction ◽  
Nerve Sheath

Background and objectives: To date, no study has investigated the ability of optic nerve sheath diameter calculated from non-contrast brain computed tomography to predict acute cerebellar infarction in patients with acute vertigo. The aim of our study was to evaluate the predictive utility of optic nerve sheath diameter for diagnosing acute cerebellar infarction in patients with acute vertigo without computed tomography abnormalities. Methods: We retrospectively enrolled patients with acute vertigo without computed tomography abnormalities who underwent magnetic resonance imaging including diffusion-weighted imaging at our emergency department between January 2016 and December 2017. Two emergency physicians independently measured optic nerve sheath diameter at 3 mm (ONSD3) and 10 mm (ONSD10) behind the globe in each patient. Final magnetic resonance imaging reports with clinical progress notes were used as the reference standard. A multivariate logistic regression analysis, receiver operating characteristic curves, and intra-class correlation coefficients were calculated to estimate predictive value. Results: A total of 34 patients (16.1%) were diagnosed with acute infarction and 177 patients (83.9%) were diagnosed with peripheral vertigo. Mean ONSD3 ( p < 0.001) and ONSD10 ( p < 0.001) were independent predictive factors for distinguishing acute infarction and peripheral vertigo. ONSD3 (cut-off = 4.22 mm) had 100% (95% confidence interval = 89.7–100.0) sensitivity and 97.7% (95% confidence interval = 95.1–99.6) specificity with area under the receiver operating characteristic curve of 0.988 (95% confidence interval = 0.978–1.0), while ONSD10 (cut-off = 3.63 mm) had 100% (95% confidence interval = 89.7–100.0) sensitivity and 87.6% (95% confidence interval = 81.8–92.0) specificity with area under the receiver operating characteristic curve of 0.976 (95% confidence interval = 0.959–0.997). There were good inter- and intra-observer agreements for both sides of ONSD3 and ONSD10 (intra-class correlation coefficient range = 0.652–0.773). Conclusion: Optic nerve sheath diameter, in particular OSND3, is a feasible predictive marker for acute infarction in patients with acute vertigo without computed tomography abnormalities. This information can assist decision-making in ordering brain magnetic resonance imaging for the assessment of acute vertigo.

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