Klinik izole sendromlu hastalarda optik sinir kılıfı çapının demografik ve klinik bulgularla ilişkisi

Öz

Amaç: Bu çalışma, demiyelinizan hastalıklar polikliniğinde takip edilen ve klinik izole sendrom (KİS) tanısı alan hastalarda optik sinir kılıfı çapı (OSKÇ) seviyelerini değerlendirmeyi ve bu seviyelerin demografik özellikler ve klinik bulgular ile ilişkisini incelemeyi amaçladı. Gereç ve Yöntemler: Bu kesitsel prospektif çalışmaya, Ocak 2024 ile Ağustos 2024 tarihleri arasında spesifik beyin omurilik sıvısı (BOS) analizi için lomber ponksiyon uygulanan CIS tanısı almış 14 hasta dahil edildi. OSKÇ, transorbital sonografi ile ölçüldü. Tüm hastaların demografik özellikleri, klinik parametreleri (BOS proteini, BOS albümini, serum albümini, immünoglobulin G indeksi ve D vitamini) kaydedildi. Bulgular: Hastaların ortalama yaşı 39,4 ± 12,8 yıl ve büyük çoğunluğu kadındı. Tüm hastalarda oligoklonal bantlar pozitif saptandı. Ortalama hastalık süresi 23,5 ± 7,6 gündü. Tüm hastalarda OSKÇ ölçümleri, her iki gözde de sagittal ve aksiyel düzlemlerde 3,1 - 5,9 mm arasında idi. OSKÇ ile yaş, hastalık süresi, BOS proteini, BOS albümini, serum albümini ve immünoglobulin G indeksi arasında güçlü bir negatif korelasyon saptandı. Sonuçlar: Bu çalışma, KİS tanısı almış hastalarda OSKÇ ile çeşitli klinik ve laboratuvar parametreleri arasında anlamlı bir ilişki olduğunu göstermiştir. Bu bulgular, OSKÇ, KİS hastalarında hastalık şiddetini ve ilerlemesini değerlendirmede değerli ve non-invaziv bir biyomarker olarak kullanılabileceğini düşündürmektedir.

Anahtar Kelimeler

• aksonal dejenerasyon
• klinik izole sendrom
• demiyelinizan hastalıklar
• multipl skleroz
• optik sinir kılıfı çapı
• transorbital sonografi

The relationship between optic nerve sheath diameter and demographic and clinical findings in patients diagnosed with clinically isolated syndrome

Öz

Aim: This study aimed to assess optic nerve sheath diameter (ONSD) levels in patients diagnosed with clinically isolated syndrome (CIS) who were being followed in the demyelinating diseases clinic, as well as to examine their relationship with demographic characteristics and clinical findings. Material and Methods: In this cross-sectional prospective study, 14 patients diagnosed with CIS who underwent lumbar puncture for specific cerebrospinal fluid (CSF) analysis were included between January 2024 and August 2024. The ONSD were measured by transorbital sonography. All patients' demographic characteristics, clinical parameters (CSF protein, CSF albumin, serum albumin, immunoglobulin G index, and vitamin D) were recorded. Results: The patients had a mean age of 39.4 ± 12.8 years, and the majority were women. Oligoclonal bands were positive in all patients. The mean disease duration was 23.5 ± 7.6 days. The ONSD measurements for all patients ranged between 3.1 and 5.9 mm in the sagittal and axial planes of both eyes. There was a strong negative correlation between ONSD levels and age, diseases duration, CSF protein, CSF albumin, serum albumin, and immunoglobulin G index. Conclusion: This study demonstrated a significant relationship between ONSD and various clinical and laboratory parameters in patients diagnosed with CIS. These findings suggest that ONSD may serve as a valuable, non-invasive marker in assessing disease severity and progression in CIS patients.

Anahtar Kelimeler

• axonal degeneration
• clinically isolated syndrome
• demyelinating diseases
• multiple sclerosis
• optic nerve sheath diameter
• transorbital sonography

Kaynakça

1. Lassmann H. Multiple Sclerosis Pathology. Cold Spring Harb Perspect Med. 2018;8(3):a028936. DOI: 10.1101/cshperspect.a028936.
2. Efendi H. Clinically Isolated Syndromes: Clinical Characteristics, Differential Diagnosis, and Management. Noro Psikiyatr Ars. 2015;52(Suppl 1):S1-S11. DOI: 10.5152/npa.2015.12608.
3. Kolcava J, Kocica J, Hulova M, et al. Conversion of clinically isolated syndrome to multiple sclerosis: a prospective study. Mult Scler Relat Disord. 2020;44:102262. DOI: 10.1016/j.msard.2020.102262.
4. Correale J, Marrodan M, and Ysrraelit MC. Mechanisms of Neurodegeneration and Axonal Dysfunction in Progressive Multiple Sclerosis. Biomedicines. 2019;7(1):14 DOI: 10.3390/biomedicines7010014.
5. Daneshvar DH and Alosco ML. In search of cost-effective and non-invasive biomarkers of traumatic brain injury. EBioMedicine. 2022;76:103823. DOI: 10.1016/j.ebiom.2022.103823.
6. Britze J and Frederiksen JL. Optical coherence tomography in multiple sclerosis. Eye (Lond). 2018;32(5):884-88. DOI: 10.1038/s41433-017-0010-2.
7. Perez Sanchez S, Eichau Madueno S, Rus Hidalgo M, et al. Usefulness of optic nerve ultrasound to predict clinical progression in multiple sclerosis. Neurologia (Engl Ed). 2021;36(3):209-14. DOI: 10.1016/j.nrl.2017.12.009.
8. Antal SI, Kincses B, Vereb D, et al. Evaluation of transorbital sonography measures of optic nerve diameter in the context of global and regional brain volume in multiple sclerosis. Sci Rep. 2023;13(1):5578. DOI: 10.1038/s41598-023-31706-5.

9. Shirodkar CG, Munta K, Rao SM, and Mahesh MU. Correlation of measurement of optic nerve sheath diameter using ultrasound with magnetic resonance imaging. Indian J Crit Care Med. 2015;19(8):466-70. DOI: 10.4103/0972-5229.162465.
10. Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018;17(2):162-73. DOI: 10.1016/S1474-4422(17)30470-2.
11. Simsek IB, Aygun D, and Yildiz S. Retinal Nerve Fibre Layer Thickness in Migraine Patients with or without Aura. Neuroophthalmology. 2015;39(1):17-21. DOI: 10.3109/01658107.2014.968740.
12. Vaiman M, Abuita R, and Bekerman I. Optic nerve sheath diameters in healthy adults measured by computer tomography. Int J Ophthalmol. 2015;8(6):1240-4. DOI: 10.3980/j.issn.2222-3959.2015.06.30.
13. Chopra A, Das PK, Parashar S, et al. Clinical Relevance of Transorbital Ultrasonographic Measurement of Optic Nerve Sheath Diameter (ONSD) for Estimation of Intracranial Pressure Following Cerebrospinal Fluid Diversion Surgery. Cureus. 2022;14(5):e25200. DOI: 10.7759/cureus.25200.
14. Stevens RRF, Gommer ED, Aries MJH, et al. Optic nerve sheath diameter assessment by neurosonology: A review of methodologic discrepancies. J Neuroimaging. 2021;31(5):814-25. DOI: 10.1111/jon.12906.
15. Munawar K, Khan MT, Hussain SW, et al. Optic Nerve Sheath Diameter Correlation with Elevated Intracranial Pressure Determined via Ultrasound. Cureus. 2019;11(2):e4145. DOI: 10.7759/cureus.4145.
16. You Y, Park J, Min J, et al. Relationship between time related serum albumin concentration, optic nerve sheath diameter, cerebrospinal fluid pressure, and neurological prognosis in cardiac arrest survivors. Resuscitation. 2018;131:42-47. DOI: 10.1016/j.resuscitation.2018.08.003.
17. Lochner P, Cantello R, Brigo F, et al. Transorbital sonography in acute optic neuritis: a case-control study. AJNR Am J Neuroradiol. 2014;35(12):2371-5. DOI: 10.3174/ajnr.A4051.
18. Schroeder C, Katsanos AH, Ayzenberg I, et al. Atrophy of optic nerve detected by transorbital sonography in patients with demyelinating diseases of the central nervous system. Eur J Neurol. 2020;27(4):626-32. DOI: 10.1111/ene.14137.
19. Padayachy L, Brekken R, Fieggen G, and Selbekk T. Pulsatile Dynamics of the Optic Nerve Sheath and Intracranial Pressure: An Exploratory In Vivo Investigation. Neurosurgery. 2016;79(1):100-7. DOI: 10.1227/NEU.0000000000001200.
20. Dutta R and Trapp BD. Pathogenesis of axonal and neuronal damage in multiple sclerosis. Neurology. 2007;68(22 Suppl 3):S22-31; discussion S43-54. DOI: 10.1212/01.wnl.0000275229.13012.32.
21. Mey GM, Mahajan KR, and DeSilva TM. Neurodegeneration in multiple sclerosis. WIREs Mech Dis. 2023;15(1):e1583. DOI: 10.1002/wsbm.1583.
22. Pau D, Al Zubidi N, Yalamanchili S, Plant GT, and Lee AG. Optic neuritis. Eye (Lond). 2011;25(7):833-42. DOI: 10.1038/eye.2011.81.
23. De Masi R, Orlando S, Conte A, et al. Transbulbar B-Mode Sonography in Multiple Sclerosis: Clinical and Biological Relevance. Ultrasound Med Biol. 2016;42(12):3037-42. DOI: 10.1016/j.ultrasmedbio.2016.07.018.
24. Hillmer L, Erhardt EB, Caprihan A, et al. Blood-brain barrier disruption measured by albumin index correlates with inflammatory fluid biomarkers. J Cereb Blood Flow Metab. 2023;43(5):712-21. DOI: 10.1177/0271678X221146127.
25. Banks WA, Farr SA, and Morley JE. Permeability of the blood-brain barrier to albumin and insulin in the young and aged SAMP8 mouse. J Gerontol A Biol Sci Med Sci. 2000;55(12):B601-6. DOI: 10.1093/gerona/55.12.b601.
26. El Mahdaoui S, Husted SR, Hansen MB, et al. Cerebrospinal fluid soluble CD27 is associated with CD8(+) T cells, B cells and biomarkers of B cell activity in relapsing-remitting multiple sclerosis. J Neuroimmunol. 2023;381:578128. DOI: 10.1016/j.jneuroim.2023.578128.
27. Koraysha NA, Kishk N, Hassan A, et al. Evaluating optic nerve diameter as a possible biomarker for disability in patients with multiple sclerosis. Neuropsychiatr Dis Treat. 2019;15:2571-78. DOI: 10.2147/NDT.S216079.