Prospective analysis of optic nerve diameter and NSE values in patients with refractory headaches
Öz
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.
Anahtar Kelimeler
Destekleyen Kurum
Çukurova University Scientific Research Projects Coordination Unit
Proje Numarası
TTU-9879
Etik Beyan
Approved by Çukurova University Faculty of Medicine Non-interventional Clinical Research Ethics Committee
Teşekkür
This study was supported by Çukurova University Scientific Research Projects Coordination Unit.
Kaynakça
- 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.
