Optic nerve sheath diameter change in prediction of malignant cerebral edema in ischemic stroke: an observational study

BMC Neurology

Seong-Joon Lee¹  Jin Soo Lee¹  Sung Eun Lee¹  Mun Hee Choi¹  Ji Man Hong¹  Ji Hyun Park²  Bumhee Park³ 

[1]Department of Neurology, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, 16499, Suwon-si, Gyeonggi-do, Republic of Korea

[2]Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea

[3]Office of Biostatistics, Medical Research Collaborating Center, Ajou Research Institute for Innovative Medicine, Ajou University Medical Center, Suwon, Republic of Korea

[4]Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea

关键词: Cerebral infarction;    Brain edema;    Optic nerve;    Ultrasonography;    Intracranial pressure;   

DOI  :  10.1186/s12883-020-01931-w

来源: Springer

【 摘 要 】

BackgroundIn acute large anterior circulation infarct patients with large core volume, we evaluated the role of optic nerve sheath diameter (ONSD) change rates in prediction of malignant progression.MethodsWe performed a retrospective observational study including patients with anterior circulation acute ischemic stroke with large ischemic cores from January 2010 to October 2017. Primary outcome was defined as undergoing decompressive surgery or death due to severe cerebral edema, and termed malignant progression. Patients were divided into malignant progressors and nonprogressors. Malignant progression was divided into early progression that occurred before D1 CT, and late progression that occurred afterwards. Retrospective analysis of changes in mean ONSD/eyeball transverse diameter (ETD) ratio, and midline shifting (MLS) were evaluated on serial computed tomography (CT). Through analysis of CT at baseline, postprocedure, and at D1, the predictive ability of time based change in ONSD/ETD ratio in predicting malignant progression was evaluated.ResultsA total of 58 patients were included. Nineteen (32.8%) were classified as malignant; 12 early, and 7 late progressions. In analysis of CTpostprocedure, A 1 mm/hr. rate of change in MLS during the CTbaseline-CTpostprocedure time phase lead to a 6.7 fold increased odds of early malignant progression (p < 0.05). For ONSD/ETD, 1%/hr. change lead to a 1.6 fold increased odds, but this association was trending (p = 0.249). In the CTD1, 1%/day change of ONSD/ETD in the CTbaseline-CTD1 time phase lead to a 1.4 fold increased odds of late malignant progression (p = 0.021) while 1 mm/day rate of change in MLS lead to a 1.5 fold increased odds (p = 0.014).ConclusionsThe rate of ONSD/ETD changes compared to baseline at D1 CT can be a predictor of late malignant progression along with MLS. ONSD/ETD change rates evaluated at postprocedure did not predict early malignant progression.

【 授权许可】

CC BY