Evaluation of optic nerve sheath diameter before and after reperfusion treatment in patients presenting to the emergency department with stroke symptoms

Background: In our study, optic nerve sheath diameter (ONSD) in acute stroke cases, and its relationship with the development of intracranial hemorrhage due to thrombolytic therapy was investigated. Method: 73 patients who applied to the KTU Medical Faculty Emergency Department between 1 September 2019 and 29 February 2020 with the symptoms of stroke were included in the study. After the first evaluation, ONSD measurements were made with bedside transorbital ultrasonography (USG) method. ONSD was measured at the 4th, 8th, and 24th hours after infusion in patients given intravenous (iv) thrombolytic therapy in the ischemic stroke group. ONSD measurement was performed in patients with ischemic stroke who did not receive reperfusion treatment at 4 and 8 hours. SPSS 23 program was used for statistical analysis of the data. The statistical significance level was accepted as p <0.05 in all analyzes. Results: 90.4% (n = 66) of the patients included in the study were diagnosed with ischemic stroke and 9.6% (n = 7) of hemorrhagic stroke. 50.7% (n = 37) of the patients were male and 49.3% (n = 36) were female. The mean age was 71.7 ± 12.3 years (min = 43, max = 97). When the right and left ONSD measurements of hemorrhagic and ischemic stroke patients at the time of presentation were compared, the difference between the two groups was statistically significant (p = 0.001 and p = 0.007). There was no significant difference in ONSD measurements between groups with and without bleeding in patients who received intravenous thrombolytic (p> 0.05). Conclusions: In our study, ONSD values were found to be significantly differentiated between hemorrhagic and ischemic stroke, and they were measured higher in those with hemorrhagic stroke. Again, according to the data we obtained, high NIHSS score and low ASPECT score measured at the time of admission may be associated with an increased risk of intracranial bleeding in patients given thrombolytic. In our study, no significant correlation was found between the ONSD value at the time of admission and the development of bleeding in patients presenting with stroke symptoms.