Optic nerve sheath diameter change in prediction of malignant cerebral edema in ischemic stroke: an observational study
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RESEARCH ARTICLE
Open Access
Optic nerve sheath diameter change in prediction of malignant cerebral edema in ischemic stroke: an observational study Seong-Joon Lee1, Mun Hee Choi1, Sung Eun Lee1, Ji Hyun Park2, Bumhee Park2,3, Jin Soo Lee1 and Ji Man Hong1*
Abstract Background: In 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. Methods: We 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. Results: A 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). Conclusions: The 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. Keywords: Cerebral infarction, Brain edema, Optic nerve, Ultrasonography, Intracranial pressure
Background Early decompressive hemicraniectomy (DHC) performed in malignant middle cerebral artery (MCA) infarction patients can reduce mortality and improve functional * Correspondence: [email protected] 1 Department of Neurology, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do 16499, Republic of Korea Full list of author information is available at the end of the article
outcomes [1]. In clinical practice, however, early DHC is not easy to apply to acute anterior circulation patients with large infarct core volumes. First, in DHC clinical trials, patients were randomized at least 12 h after onset [2], and usually did not include the patients in which intravenous (IV) thrombolysis was per
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