Effectiveness of computerized tomography optic nerve sheath diameter measurement in predicting outcome of the patients with sontaneous intracranial hemorrhage

Introduction: Measurement of optic nerve sheath diameter (ONSD) in cranial computed tomography (CCT) images is a noninvasive method and can be used as a diagnostic tool to demonstrate the prognosis of patients in the ED due to the fact that it can be measured from the present CCT images without requiring additional procedures. To test this hypothesis, we aimed to evaluate whether the measurements of ONSD in patients with intracranial hemorrhage are predictive of mortality or relation to prognosis. Materials and Methods: In this study, we evaluated all patients who were admitted to the Dokuz Eylul University Emergency Department in the last four years (01.01.2014-01.01.2018) and who were diagnosed with non-traumatic intracranial hemorrhage by computerized tomography. ONSD measurements were made using PACS system by radiology physicians who were blinded to patient information. The demographic data, length of hospital stay, the wards they were admitted to, the treatments such as medication or surgery, mortality rates and relationship of this data with ONSD measurements investigated. Results: One hundred forty two patients were enrolled to this study. The most frequent type of bleeding on CCT was subarachnoid hemorrhage (SAH) (N = 83, 58.5%). A significant relationship was found between the mortality and high systolic, diastolic blood pressure, low GCS and low oxygen saturation. In comparison bilateral hemorrhages had increased ONSD than unilateral hemorrhage. All measurements was found to be higher in patients with SAH. Compared with the specific treatments applied to the patients and the ONSD measurements, it was observed that the patients who had undergone surgical interventions (operation and / or interventional treatment) were found to be thicker (p <0.001 and p = 0.001). In terms of the need for surgical intervention, the sensitivity was 55.9% and specificity was 67.5% in the right eye for ONSD> 5.05 (AUC 0.672; 95% CI 0.583-0.762). In the left eye, sensitivity was 61% and specificity was 64% for OSND> 5.05 (AUC: 0,668; 95% CI: 0,579-0,757). The relationship between mortality and bleeding, in the right eye the sensitivity was %55,7 and specificity was % 72,8 for ONSD>5,15 (AUC 0,667; %95 GA 0,577-0,756), in the left eye the sensitivity was %60,7 and specificity was % 70,4 for ONSD>5,05 (AUC: 0,652; %95 GA: 0,559-0,744). Conclusion: ONSD measurements were higher in bilateral hemorrhages and SAH. When ED outcomes were evaluated, patients who died, admitted to hospital or the intensive care unit, patients who needed surgical / interventional treatment ONSD were wider. On the other hand, these measurements have a low sensitivity to use of predicting the need for surgical intervention, mortality and intensive care. Therefore, in the evaluation of the prognosis of the patients, ONSD is not a sufficient criterion. Keywords: spontaneous intracranial hemorrhage, optic nerve sheath diameter, computerized brain tomography, subarachnoid hemorrhage, intracranial hematoma