Correlation of diameter of the optic nerve sheath and clinical outcomes in patients with intracerebral hemorrhage based on the intracerebral hemorrhage score

Abstract

Hemorrhagic stroke is classified according to its anatomical location into intracerebral, subarachnoid, and intraventricular hemorrhages. Increased intracerebral pressure (ICP) can result in poor outcomes in patients with hemorrhagic stroke. Ultrasonography (USG) of the optic nerve sheath diameter (ONSD) has been suggested as a noninvasive method for detecting elevated ICP. Previous studies have indicated that an ONSD greater than 5 mm correlates with an ICP > 20 mmHg. This study aimed to examine the relationship between ONSD and clinical outcomes in intracerebral hemorrhagic stroke patients with ICH according to the intracerebral hemorrhage (ICH) score. This observational cross-sectional study was conducted from March to June 2021 at Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia, and included 52 patients with acute intracerebral hemorrhage stroke patients. Each patient underwent brain CT, and ICH scores were obtained upon admission. ONSD sonography was performed 48 h after admission. Fisher's exact test was used to examine the relationship between ONSD and clinical outcomes, whereas Spearman’s rank correlation coefficient was used to assess the strength of the correlation. A strong positive correlation was found between ONSD and ICH scores (r = 0.618, p < 0.000). The significant components of the ONSD-associated ICH score were the GCS score (p = 0.001), ICH volume (p = 0.000), and the presence of IVH (p = 0.009). This study concluded that ONSD was a non-invasive and cost-effective method to assess increased ICP in patients with intracerebral hemorrhagic stroke, showed a correlation with clinical outcomes according to the ICH score.

Keywords

• Optic nerve sheath diameter
• intracerebral hemorrhagic stroke
• USG
• clinical outcome
• ICH score

Ethical Statement

This study was approved by the Health Research Ethics Committee of the Faculty of Medicine, Universitas Syiah Kuala-Dr. Zainoel Abidin General Hospital (RSUZA), Banda Aceh, Indonesia (No. 069/EA/FK-RSUZA/2021, March 17, 2021).

Thanks

The authors would like to thank the patients at Dr. Zainoel Abidin General Hospital (RSUZA), Banda Aceh who participated in this study.

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