The Ultrasound Examination of the Optic Nerve Sheath Diameter in the Patients Presenting with Carbon Monoxide Poisoning: A pilot study

Year 2023, Volume: 13 Issue: 1, 1 - 5, 26.04.2023

Emel Altıntaş Sertaç Güler Hayri Ramadan

Abstract

Aim: In carbon monoxide poisoning, hypoxia results in neuronal damage and death of brain cells. It is considered that cerebral edema occurs consequently, with an associated increase in intracranial pressure. The present study evaluates the presence of increased intracranial pressure using the measurement of optic nerve sheath diameter by ultrasonography in patients presenting with carbon monoxide poisoning.
Material and Method: Twenty-eight patients diagnosed with carbon monoxide poisoning after presenting to the emergency department underwent the bilateral measurement of optic nerve sheath diameter by ultrasonography. In addition, the patient’s demographic data, laboratory results, stage of the poisoning, and optic nerve sheath diameters were recorded.
Results: The median optic nerve sheath diameter on the right and left sides was greater than 5 mm. The optic nerve sheath diameter of the right and the left eye was significantly higher in patients with severe carbon monoxide poisoning than in those with moderate and mild poisoning. Conclusion: The optic nerve sheath diameter measurement can be used to evaluate increased intracranial pressure in patients with carbon monoxide poisoning.

Keywords

monoxide poisoning, elevated intracranial pressure, ultrasonography, optic nerve sheath diameter

References

• 1. Smollin C, Olson K. Carbon monoxide poisoning (acute). BMJ Clin Evid. 2010;2010.
• 2. Eichhorn L, Thudium M, Jüttner B. The Diagnosis and Treatment of Carbon Monoxide Poisoning. Dtsch Arztebl Int. 2018;115(51-52):863–870.
• 3. Saria MG, Kesari S. Increased Intracranial Pressure: The Use of an Individualized Ladder Approach. Seminars in oncology nursing. 2021:151133.
• 4. Chung-Ping Lo, Shao-Yuan Chen, Kwo-Whei Lee, Wei-Liang Chen, Cheng-Yu Chen et al. Brain injury after acute carbon monoxide poisoning: early and late complications. AJR Am J Roentgenol 189(4):W205-211.
• 5. Kavak N, Doğan B, Sultanoğlu H, Kavak RP, Özdemir MJKD. Clinical and Magnetic Resonance Imaging Findings of Patients with Acute Carbon Monoxide Poisoning.12(3):443-50.
• 6. Girisgin AS, Kalkan E, Kocak S, Cander B, Gul M, et al. The role of optic nerve ultrasonography in the diagnosis of elevated intracranial pressure. Emerg Med J. 2007;24(4):251–4.
• 7. Robba C, Santori G, Czosnyka M, Corradi F, Bragazzi N, et al.Optic nerve sheath diameter measured sonographically as noninvasive estimator of intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2018;44(8):1284–1294.
• 8. Miller MT, Pasquale M, Kurek S, White J, Martin P, et al. Initial head computed tomographic scan characteristics have a linear relationship with initial intracranial pressure after trauma. J Trauma. 2004;56(5):967–72.
• 9. Major R, Girling S, Boyle A. Ultrasound measurement of optic nerve sheath diameter in patients with a clinical suspicion of raised intracranial pressure. Emerg Med J. 2011;28(8):679–81. doi:10.1136/emj.2009.087353.
• 10. Nah S, Choi S, Kim HB, Lee J, Lee SU, et al. Cerebral White Matter Lesions on Diffusion-Weighted Images and Delayed Neurological Sequelae after Carbon Monoxide Poisoning: A Prospective Observational Study. Diagnostics (Basel, Switzerland). 2020;10(9).
• 11. Han S-T, Bhopale VM, Thom SR. 2007. Xanthine oxidoreductase and neurological sequelae of carbon monoxide poisoning. Toxicol Lett. 170(2):111–115.
• 12. Blaivas M, Theodoro D, Sierzenski PR. A study of bedside ocular ultrasonography in the emergency department. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine. 2002;9(8):791–9.
• 13. Gökcen E, Caltekin İ, Savrun A, Korkmaz H, Savrun Ş T, et al. Alterations in optic nerve sheath diameter according to cerebrovascular disease sub-groups. The American journal of emergency medicine. 2017;35(11):1607–11.
• 14. Ropper AH, Shafran B. Brain edema after stroke. Clinical syndrome and intracranial pressure. Arch Neurol. 1984;41:269.
• 15. Schwab S, Schwarz S, Spranger M, Keller E, Bertram et al. Moderate hypothermia in the treatment of patients with severe middle cerebral artery infarction. Stroke. 1998;29:2461–6.
• 16. Morley NC, Berge E, Cruz-Flores S, Whittle IR. Surgical decompression for cerebral oedema in acute ischaemic stroke. Cochrane Database Syst Rev. 2002;3: CD003435.
• 17. O’Donnell P, Buxton PJ, Pitkin A. The magnetic resonance imaging appearances of the brain in acute carbon monoxide poisoning. Clin Radiol. 2000; 55(4):273–280.
• 18. T Miura, M Mitomo, R Kawai, K Harada. CT of the brain in acute carbon monoxide intoxication: characteristic features and prognosis. Am J Neuroradiol. 1985; 6(5):739–742.
• 19. Jeon S-B, Sohn CH, Seo D-W, Oh BJ, Lim KS, et al.2018. Acute brain lesions on magnetic resonance imaging and delayed neurological sequelae in carbon monoxide poisoning. JAMA Neurol. 75(4):436–443.
• 20. Kim YS, Cha YS, Kim MS, Kim HJ, Lee YS, et al. The usefulness of diffusion-weighted magnetic resonance imaging performed in the acute phase as an early predictor of delayed neuropsychiatric sequelae in acute carbon monoxide poisoning. Human & experimental toxicology. 2018;37(6):587–95.
• 21. Kokulu K, Mutlu H, Sert ET. 2020. Serum netrin-1 levels at presentation and delayed neurological sequelae in unintentional carbon monoxide poisoning. Clin Toxicol (Philadelphia, Pa). 58(12):1313–1317.