The association between intracranial pressure and optic nerve sheath diameter on patients with head trauma

Abstract

Background: Although intracranial pressure (ICP) monitoring is the gold standard method for measuring intracranial pressure after traumatic brain injury, optic nerve sheath diameter (ONSD) measurement with ultrasound (US) is also used in the evaluation of ICP. Objective: To investigate the association between a series of OSND measurements by US and changes in clinical presentation of the patient. Methods: Prospective study including 162 patients with traumatic brain injury. Age, sex, cerebral CT findings, ONSD levels by US at minutes 0, 60, and 120, Glasgow Coma Scale (GCS) within same period, change of consciousness, treatment, and mortality data were reviewed. The association of ONSD levels with GCS, change of consciousness, treatment, and mortality was evaluated. Results: There was no difference in ONSD changes in the patients’ sample within the period (p=0.326). ONSD significantly increased in patients who died (p<0.001), but not in those who survived (p=0.938). There was no significant change in ONSD of the patients who received anti-edema therapy (p=801), but significantly increased ONSD values were found in those who received anti-edema therapy (p=0.03). Patients without change of consciousness did not have any significant change in ONSD (p=0.672), but ONSD values increased in patients who consciousness became worse, and decreased in those who presented a recovery (respectively, p<0.001, p=0.002). A negative correlation was detected between ONSD values and GSC values measured at primary, secondary, and tertiary time periods (for all p<0.001). Conclusions: ONSD follow-up may be useful to monitor ICP increase in patients with acute traumatic brain injury.

RESUMO

Antecedentes: Embora o monitoramento da pressão intracraniana (PIC) seja o método padrão-ouro para medir a pressão intracraniana após lesão encefálica traumática, a medição do diâmetro da bainha do nervo óptico (DBNO) com ultrassom (US) também é usada na avaliação da PIC. Objetivo: Investigar a associação entre uma série de medidas de DBNO por US e mudanças na apresentação clínica do paciente. Métodos: Estudo prospectivo incluindo 162 pacientes com traumatismo cranioencefálico. Idade, sexo, achados de TC cerebral, níveis de DBNO por US nos minutos 0, 60 e 120, Escala de Coma de Glasgow (GCS) no mesmo período, mudança de consciência, tratamento e dados de mortalidade foram revisados. A associação dos níveis de DBNO com GCS, mudança de consciência, tratamento e mortalidade foi avaliada. Resultados: Não houve diferença nas mudanças de DBNO na amostra de pacientes no período (p=0,326). O DBNO aumentou significativamente em pacientes que morreram (p<0,001), mas não naqueles que sobreviveram (p=0,938). Não houve mudança significativa no DBNO dos pacientes que receberam terapia antiedema (p=801), mas valores significativamente aumentados de DBNO foram encontrados naqueles que receberam terapia antiedema (p=0,03). Pacientes sem alteração da consciência não tiveram alteração significativa no DBNO (p=0,672), mas os valores do DBNO aumentaram nos pacientes que pioraram a consciência e diminuíram naqueles que apresentaram recuperação (respectivamente, p<0,001, p=0,002). Detectou-se correlação negativa entre os valores de DBNO e os valores de GSC medidos nos períodos primário, secundário e terciário (para todos, p<0,001). Conclusões: O acompanhamento do DBNO pode ser útil para monitorar o aumento da PIC em pacientes com lesão cerebral traumática aguda.

Keywords:

Brain Injuries, Traumatic - Optic Nerve Neoplasms - Glasgow Coma Scale - Mortality

Palavras-chave:

Lesões Encefálicas Traumáticas - Neoplasias do Nervo Óptico - Escala de Coma de Glasgow - Mortalidade

Authors’ contributions:

BED, KÇ: contributed substantially to the conception or design of the study; KÇ: contributed to the collection, analysis, or interpretation of data; BED, KÇ: contributed to the writing or critical review of the manuscript; BED, KÇ: contributed to the approval of the final version to be published.

Publication History

Received: 14 October 2020

Accepted: 09 November 2020

Article published online:
07 June 2023

• References

• 1 Bar J, Rosenberg J, Chan W, Panebianco N. Pearls & Oy-sters: Diagnosis and monitoring of elevated intracranial pressure through ultrasound of the optic nerve. Neurology. 2019 Feb;92(6):299-301. https://doi.org/10.1212/WNL.20200478202004786888.
• 2 Marehbian J, Muehlschlegel S, Edlow BL, Hinson HE, Hwang DY. Medical management of the severe traumatic brain injury patient. Neurocrit Care. 2017 Dec;27(3):430-46. https://doi.org/10.1007/s12028-017-0408-5
• 3 Dilmen ÖK, Akçıl EF, Tunalı Y. Intensive care treatment in traumatic brain injury. Turk J Anaesthesiol Reanim. 2015 Feb;43(1):1-6. https://doi.org/10.5152/TJAR.2014.26680
• 4 Hussain E. Traumatic brain injury in the pediatric intensive care unit. Pediatr Ann. 2018 Jul 1;47(7):e274-9. https://doi.org/10.3928/19382359-20180619-01
• 5 Vella MA, Crandall ML, Patel MB. Acute management of traumatic brain injury. Surg Clin North Am. 2017 Oct;97(5):1015-30. https://doi.org/10.1016/j.suc.2017.06.003
• 6 Robba C, Bacigaluppi S, Cardim D, Donnelly J, Bertuccio A, Czosnyka M. Non-invasive assessment of intracranial pressure. Acta Neurol Scand. 2016 Jul;134(1):4-21. https://doi.org/10.1111/ane.12527
• 7 Sekhon MS, Griesdale DE, Robba C, McGlashan N, Needham E, Walland K, et al. Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury. Intensive Care Med. 2014 Sep;40(9):1267-74. https://doi.org/10.1007/s00134-014-3392-7c
• 8 Luerssen TG, editor Intracranial pressure: current status in monitoring and management. Semin Pediatr Neurol. 1997 Sep;4(3):146-55. https://doi.org/10.1016/s1071-9091(97)80033-2
• 9 M Czosnyka M, Pickard JD. Monitoring and interpretation of intracranial pressure. Neuroscience for neurologists J Neurol Neurosurg Psychiatry. 2004 Jun;75(6):813-21. https://doi.org/10.1136/jnnp.2003.033126
• 10 Moretti R, Pizzi B, Cassini F, Vivaldi N. Reliability of optic nerve ultrasound for the evaluation of patients with spontaneous intracranial hemorrhage. spontaneous intracranial hemorrhage. Neurocrit Care. 2009 Dec;11(3):406-10. https://doi.org/10.1007/s12028-009-9250-8
• 11 Jenjitranant P, Tunlayadechanont P, Prachanukool T, Kaewlai R. Correlation between optic nerve sheath diameter measured on imaging with acute pathologies found on computed tomography of trauma patients. Eur J Radiol. 2020 Apr;125:108875. https://doi.org/10.1016/j.ejrad.2020.108875
• 12 Kerscher SR, Schöni D, Hurth H, Neunhoeffer F, Haas-Lude K, Wolff M, et al. The relation of optic nerve sheath diameter (ONSD) and intracranial pressure (ICP) in pediatric neurosurgery practice-Part I: correlations, age-dependency and cut-off values. Childs Nerv Syst. 2020 Jan;36(1):99-106. https://doi.org/10.1007/s00381-019-04266-1
• 13 Khan MN, Shallwani H, Khan MU, Shamim MS. Noninvasive monitoring intracranial pressure–A review of available modalities. Surg Neurol Int. 2017 Apr;8:51. https://doi.org/10.4103/sni.sni_403_16
• 14 Kim S-E, Hong EP, Kim HC, Lee SU, Jeon JP. Ultrasonographic optic nerve sheath diameter to detect increased intracranial pressure in adults: a meta-analysis. Acta Radiol. 2019 Feb;60(2):221-9. https://doi.org/10.1177/0284185118776501
• 15 Ünlü AR, Ülger F, Dilek A, Barış S, Murat N, Sarıhasan B. Evaluation of the relationship between revised trauma score, and trauma and injury severity scores with prognosis of trauma patients in intensive care unit. Turk J Anaesthesiol Reanim 2012 Jun;40(3):128-35. https://doi.org/10.5222/JTAICS.2012.128
• 16 Neklapilová V, Zelnícek P. Epidemiology of severe injuries from the viewpoint of the trauma center. Cas Lek Cesk. 2003;142(11):676-8.
• 17 Ahun E, Köksal Ö, Sığırlı D, Gökhan Torun G, Dönmez SS, Armağan E. Value of the Glasgow coma scale, age, and arterial blood pressure score for predicting the mortality of major trauma patients presenting to the emergency department. Ulus Travma Acil Cerrahi Derg. 2014 Jul;20(4):241-7. https://doi.org/10.5505/tjtes.2014.76399
• 18 Püsküllüoğlu S, Açıkalın A, Ay M, Kozacı N, Avcı A, Gülen M, et al. Analysis of adult trauma patients admitted to emergency department. Çukurova Med J. 2015 Apr;40(3):569-79.
• 19 Adıyaman E, Tokur ME, Bal ZM, Gökmen AN, Koca U. Retrospective analysis of trauma patients who were treated and followed in anesthesia intensive care unit. J Turk Soc Intens Care. 2019 Mar;17(3):146-53. https://doi.org/10.4274/tybd.galenos.2018.82905
• 20 Kara İ, Altınsoy S, Gök U, Onur A, Sarıbapıcçı R. Mortality analysis of trauma patients in general intensive care unit of a state hospital. Türk Yoğun Bakım Derneği Dergisi. 2015 Aug;13(2):68-74. https://doi.org/10.4274/tybdd.54154
• 21 Işık HS, Bostancı U, Yıldız Ö, Özdemir C, Gökyar A. Retrospective analysis of 954 adult patients with head injury: an epidemiological study. Ulus Travma Acil Cerrahi Derg. 2011;17(1):46-50. https://doi.org/10.5505/TJTES.2011.57431
• 22 Lee D, Lee B, Noh S, Cho Y. High fibrin/fibrinogen degradation product to fibrinogen ratio is associated with 28-day mortality and massive transfusion in severe trauma. Eur J Trauma Emerg Surg. 2018 Apr;44(2):291-8. https://doi.org/10.1007/s00068-017-0844-0
• 23 Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010.
• 24 Dur A, Koçak S, Cander B, Sönmez E, Civelek C. Factors affecting mortality in patients with multitrauma which were treated in intensive care unit. Dicle Tip Dergisi. 2013 Jan;40(2):177-82. https://doi.org/10.5798/diclemedj.0921.2013.02.0251
• 25 Isokuortti H, Iverson GL, Silverberg ND, Kataja A, Brander A, Öhman J, et al. Characterizing the type and location of intracranial abnormalities in mild traumatic brain injury. J Neurosurg. 2018 Dec;129(6):1588-97. https://doi.org/10.3171/2017.7.JNS17615.
• 26 Dunham CM, Malik RJ, Huang GS, Kohli CM, Brocker BP, Ugokwe KT. Hypertonic saline administration and complex traumatic brain injury outcomes: a retrospective study. Int J Burns Trauma. 2018 Jun;8(3):40-53.
• 27 Siwicka-Gieroba D, Malodobry K, Biernawska J, Robba C, Bohatyrewicz R, Rola R, et al. The neutrophil/lymphocyte count ratio predicts mortality in severe traumatic brain injury patients. J Clin Med. 2019 Sep;8(9):1453. https://doi.org/10.3390/jcm8091453
• 28 Legrand A, Jeanjean P, Delanghe F, Peltier J, Lecat B, Dupont H. Estimation of optic nerve sheath diameter on an initial brain computed tomography scan can contribute prognostic information in traumatic brain injury patients. Crit Care. 2013 Mar;17(2):R61. https://doi.org/10.1186/cc12589
• 29 Naldi A, Pivetta E, Coppo L, Cantello R, Comi C, Stecco A, et al. Ultrasonography monitoring of optic nerve sheath diameter and retinal vessels in patients with cerebral hemorrhage. J Neuroimaging. 2019 May;29(3):394-9. https://doi.org/10.1111/jon.12604
• 30 Geeraerts T, Launey Y, Martin L, Pottecher J, Vigué B, Duranteau J, et al. Ultrasonography of the optic nerve sheath may be useful for detecting raised intracranial pressure after severe brain injury. Intensive Care Med. 2007 Oct;33(10):1704-11. https://doi.org/10.1007/s00134-007-0797-6
• 31 Lim TK, Yu BC, Ma DS, Lee GJ, Lee MA, Hyun SY, et al. Correlation between optic nerve sheath diameter measured by computed tomography and elevated intracranial pressure in patients with traumatic brain injury. J Trauma Inj. 2017 Dec;30(4):140-4. https://doi.org/10.20408/jti.2017.30.4.140
• 32 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(6):963-7. https://doi.org/10.1016/j.ajem.2016.02.012
• 33 Vaiman M, Sigal T, Kimiagar I, Bekerman I. Intracranial pressure assessment in traumatic head injury with hemorrhage via optic nerve sheath diameter. J Neurotrauma. 2016 Dec;33(23):2147-53. https://doi.org/10.1089/neu.2015.4293
• 34 Sönmez BM, Temel E, İşcanlı MD, Yılmaz F, Gülöksüz U, Parlak S, et al. Is initial optic nerve sheath diameter prognostic of specific head injury in emergency departments? J Natl Med Assoc. 2019 Apr;111(2):210-7. https://doi.org/10.1016/j.jnma.2018.10.009.
• 35 Hon KL, Huang S, Poon WS, Cheung HM, Ip P, Zee B. Mortality and morbidity of severe traumatic brain injuries; a pediatric intensive care unit experience over 15 years. Bull Emerg Trauma. 2019 Jul;7(3):256-62. https://doi.org/10.29252/beat-070308
• 36 Karakitsos D, Soldatos T, Gouliamos A, Armaganidis A, Poularas J, Kalogeromitros A, et al. Transorbital sonographic monitoring of optic nerve diameter in patients with severe brain injury. Transplant Proc. 2006 Dec;38(10):3700-6. https://doi.org/10.1016/j.transproceed.2006.10.185
• 37 Al Saiegh F, Philipp L, Mouchtouris N, Chalouhi N, Khanna O, Shah SO, et al. Comparison of outcomes of severe traumatic brain injury in 36,929 patients treated with or without intracranial pressure monitoring in a mature trauma system. World Neurosurg. 2020 Apr;136:e535-e541. https://doi.org/10.1016/j.wneu.2020.01.070
• 38 Thotakura A, Marabathina N, Danaboyina A, Mareddy R. Role of serial ultrasonic optic nerve sheath diameter monitoring in head injury. Neurochirurgie. 2017 Dec;63(6):444-8. https://doi.org/10.1016/j.neuchi.2017.06.001
• 39 Lazaridis C, Rusin CG, Robertson CS. Secondary brain injury: predicting and preventing insults. Neuropharmacology. 2019 Feb;145(Pt B):145-52. https://doi.org/10.1016/j.neuropharm.2018.06.005