Dirençli baş ağrısı olan hastalarda optik sinir çapı ve NSE değerlerinin prospektif analizi

Year 2024, Volume: 49 Issue: 1, 121 - 129, 29.03.2024

Naciye Orçan Ayça Açıkalın Gülçin Dağlıoğlu Ömer Taşkın Rana Dişel Özge Bakışkan Tombul Merve Türker

https://doi.org/10.17826/cumj.1395889

Abstract

Amaç: Bu çalışmanın amacı, acil serviste dirençli baş ağrısı olan hastalarda ultrasonografik optik sinir çapı ölçümü ve plazma nöron spesifik enolaz (NSE) düzeyinin ikincil baş ağrısı nedenlerini saptamada kullanılabilirliğini araştırmaktır.
Gereç ve Yöntem: Çalışma, bir üniversite hastanesi erişkin acil servisinde, 3 yılı aşkın bir süre boyunca yürütülmüştür. Acil servise dirençli baş ağrısı ile başvuran 66 hasta ve kontrol grubu olarak 50 sağlıklı gönüllü çalışmaya dahil edilmiştir. Hastaların şikayetlerinin süresi, baş ağrısının tipi ve yeri, semptomları, eşlik eden hastalıkları, görüntüleme sonuçları, optik sinir çapları, laktat, arteriyel kan gazı ve NSE düzeyleri kaydedilmiştir.
Bulgular: Çalışmaya 33'ü kadın olmak üzere toplam 66 hasta dahil edildi. Yaş ortalaması 43.05±17.06 idi. Hastaların 45'inde (%68.2) ikincil baş ağrısı nedenleri saptandı. Ultrasonografik optik sinir çapı değerlendirildiğinde, 17 (%25.8) sağ ve 21 (%31.8) sol optik sinir çapının ≥5 mm olduğu tespit edildi. Sekonder baş ağrısı tanısı alan hastalarda sağ ve sol optik sinir çapı değerleri anlamlı olarak yüksek bulunurken, NSE değerlerinde istatistiksel olarak anlamlı bir fark bulunmadı. Sekonder baş ağrısı olan hastalarda laktat düzeyleri primer baş ağrısı olan hastalara göre istatistiksel olarak anlamlı derecede yüksekti.
Sonuç: Dirençli baş ağrısı ile acil servise başvuran ve görüntülemesi normal olan hastalarda, ultrasonografik optik sinir çapı ölçümü, ikincil nedenlerin saptanmasına rehberlik etmek için kolay erişilebilir bir yöntem olarak tercih edilebilir. NSE, ikincil baş ağrısı olan hastaların erken seçiminde etkili bir yöntem değildir.

Keywords

Baş ağrısı, nöron spesifik enolaz, optik sinir çapı

Project Number

TTU-9879

Prospective analysis of optic nerve diameter and NSE values in patients with refractory headaches

Abstract

Purpose: This study aims to investigate the usability of ultrasonographic optic nerve diameter measurement and plasma neuron-specific enolase (NSE) levels in detecting secondary causes of headaches in patients with refractory headaches in emergency department.
Materials and Methods: The study was conducted in a university-based adult emergency department over 3 years. Sixty-six consecutive patients presenting to the emergency department with refractory headaches and 50 healthy volunteers for the control group were included. Information recorded included the duration of complaints, type and location of headache, symptoms, co-morbidities, results of imaging studies, optic nerve diameters, results of lactate, arterial blood gas and NSE levels.
Results: A total of 66 patients were included, comprising 33 females. The mean age was 43.05 ± 17.06 years. Secondary causes of headache were identified in 45 patients (68.2%). Evaluation of ultrasonographic optic nerve diameter revealed that 17 (25.8%) right and 21 (31.8%) left optic nerve diameters were ≥5 mm. Optic nerve diameter values were significantly higher in patients diagnosed with secondary headache compared to those with primary headache, with no statistically significant difference observed in NSE values. Lactate levels in patients with secondary headaches were significantly higher than those in patients with primary headaches.
Conclusion: In patients admitted to the emergency department with refractory headaches and normal imaging, ultrasonographic optic nerve diameter measurement may be preferred as an easily accessible method to guide the detection of secondary causes. NSE was not an effective in the early selection of patients with secondary headaches.

Keywords

Headache, Neuron specific enolase, optic nerve diameter

Ethical Statement

Approved by Çukurova University Faculty of Medicine Non-interventional Clinical Research Ethics Committee

Supporting Institution

Çukurova University Scientific Research Projects Coordination Unit

Project Number

TTU-9879

Thanks

This study was supported by Çukurova University Scientific Research Projects Coordination Unit.

References

• Nye BL, Ward TN. Clinic and emergency room evaluation and testing of headache. Headache. 2015;55:1301-8.
• Robbins MS. Diagnosis and management of headache: a review. JAMA. 2021;325:1874-85.
• Dubourg J, Javouhey E, Geeraerts T, Messerer M, Kassai B. Ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2011;37:1059-68.
• Hassen GW, Bruck I, Donahue J, Mason B, Sweeney B, Saab W, et al. Accuracy of optic nerve sheath diameter measurement by emergency physicians using bedside ultrasound. J Emerg Med. 2015;48:450-7.
• Kimberly HH, Noble VE. Using MRI of the optic nerve sheath to detect elevated intracranial pressure. Crit Care. 2008;12:181-2.
• Komut E, Kozacı N, Sönmez BM, Yılmaz F, Komut S, Yıldırım ZN et al. Bedside sonographic measurement of optic nerve sheath diameter as a predictor of intracranial pressure in ED. Am J Emerg Med. 2016;34:963-7.
• Marangos PJ, Schmechel DE. Neuron specific enolase, a clinically useful marker for neurons and neuroendocrine cells. Annu Rev Neurosci. 1987;10:269-95.
• Takmaz İ. Ağır kafa travmalarında serumda protein S100B ve Nöron Spesifik Enolaz'ın prognostik değeri (Uzmanlık tezi). Diyarbakır, Dicle Üniversitesi, 2015.
• Frumin E, Schlang J, Wiechmann W, Hata S, Rosen S, Anderson C et al. Prospective analysis of single operator sonographic optic nerve sheath diameter measurement for diagnosis of elevated intracranial pressure. West J Emerg Med. 2014;15:217-7.
• Tintinalli J. Tintinalli's Emergency Medicine : A Comprehensive Study Guide (8th Ed.). 2016.
• Wolf SJ, Byyny R, Carpenter CR, Diercks DB, Gemme SR, Gerardo SJ et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with acute aeadache. Ann emerg med. 2019/10// 2019;74:e41-e74.
• Saper JR, Hamel RL, Lake AE. Medication overuse headache (MOH) is a biobehavioural disorder. Cephalalgia. 2005;25:545-46.
• Walling A. Headache: Headache emergencies. FP Essent. 2018;473:21-5.
• Benseñor IM, Lotufo PA, Goulart AC, Menezes PR, Scazufca M. The prevalence of headache among elderly in a low-income area of São Paulo, Brazil. Cephalalgia. 2008;28:329-33.
• Kaniecki RG, Levin AD. Headache in the elderly. Handb Clin Neurol. 2019;167:511-28.
• Tai ML, Jivanadham JS, Tan CT, Sharma VK. Primary headache in the elderly in South-East Asia. J Headache Pain. 2012;13:291-7.
• Lynch KM, Brett F. Headaches that kill: a retrospective study of incidence, etiology and clinical features in cases of sudden death. Cephalalgia. 2012;32:972-8.
• Oliveira FAA, Sampaio Rocha-Filho PA. Headaches attributed to ischemic stroke and transient ischemic attack. Headache. 2019;59:469-76.
• Edlow JA, Fisher J. Diagnosis of subarachnoid hemorrhage: time to change the guidelines? Stroke. 2012;43:2031-2.
• Uggetti C, Khouri Chalouhi K, Squarza S, Frediani F, Cariati M. Headache in the emergency department: the role of imaging. Neurol Sci. 2018;39:151-2.
• Damiani D, Damiani D, Morumbi A, Doutor R, Lima A. Non-invasive intracranial pressure evaluation in an emergency room – point-of-care ultrasonography. Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery. 2019;38:279-83.
• Blaivas M, Theodoro D, Sierzenski PR. Elevated intracranial pressure detected by bedside emergency ultrasonography of the optic nerve sheath. Acad Emerg Med. 2003;10:376-81.
• Jang T, Aubin C. The use of serial ocular ultrasonography in the care of patients with head injury. Ann Emerg Med. 2005;45:336-7.
• Wood JH. Physiology, pharmacology, and dynamics of cerebrospinal fluid. In Neurobiology of Cerebrospinal Fluid 1 (Ed JH Wood):1-16..Springer, Boston, MA. 1980.
• Liu D, Kahn M. Measurement and relationship of subarachnoid pressure of the optic nerve to intracranial pressures in fresh cadavers. Am J Ophthalmol. 1993;116:548-56.
• Ueno T, Ballard RE, Macias BR, Yost WT, Hargens AR. Cranial diameter pulsations measured by non-invasive ultrasound decrease with tilt. Aviat Space Environ Med. 2003;74:882-5.
• Canakci Y, Koksal O, Durak VA. The value of bedside ocular ultrasound assessment of optic nerve sheath diameter in the detection of increased intracranial pressure in patients presenting to the emergency room with headache. Niger J Clin Pract. 2018;21:778-82.
• Bekerman I, Sigal T, Kimiagar I, Almer ZE, Vaiman M. Diagnostic value of the optic nerve sheath diameter in pseudotumor cerebri. J Clin Neurosci. 2016;30:106-9.
• Sharma R, Macy S, Richardson K, Lokhnygina Y, Laskowitz DT. A blood-based biomarker panel to detect acute stroke. J Stroke Cerebrovasc Dis. 2014;23:910-8.
• Abbas A, Aukrust P, Dahl TB, Bjerkeli V, Sagen EB, Michelsen A et al. High levels of S100A12 are associated with recent plaque symptomatology in patients with carotid atherosclerosis. Stroke. 2012;43:1347-53.
• Raabe A, Grolms C, Keller M, Döhnert J, Sorge O, Seifert V. Correlation of computed tomography findings and serum brain damage markers following severe head injury. Acta Neurochir (Wien). 1998;140:787-91.
• Casmiro M, Scarpa E, Cortelli P, Vignatelli L. Cerebrospinal fluid and serum neuron-specific enolase in acute benign headache. Cephalalgia. 2008;28:506-9.