Assessment of the distinction between ischemic/hemorrhagic stroke by measuring optic nerve sheath diameter with ultrasonography in the emergency department

Introduction: Treatment protocols for ischemic and hemorrhagic stroke are very different from each other. Making this differential diagnosis quickly is of great importance in terms of applying the right treatment without wasting time and contributing to the comfort of the patient for the rest of his life. Serebrovasculer diseases causes increased intracranial pressure and one way of assessing this is ocular ultrasonography. In this study, we aimed to confirm the differential diagnosis between serebrovasculer diseases subgroups through finding a cut-off by measuring the optic nerve sheath diameter with bedside ultrasonography. Methods: Our study is a prospective and observational study conducted in Ankara City Hospital Emergency Medicine Clinic between April 2021 and September 2021. Patients over the age of 18 who had spontaneous respiration applying to the emergency department with the symptoms of stroke were included in our study. The demographic characteristics of the patients and the optic nerve sheath diameter measurements evaluated by bedside ultrasound were recorded. Results: The mean age of 64 stroke patients (30 hemorrhagic, 34 ischemic) included in the study was 69±17, and 28 (43.8%) were female. The mean optic nerve sheath diameter was found to be 6,45±0,29 mm in the hemorrhagic group and 5,41±0,30 mm in the ischemic group. We found that we confirmed the differential diagnosis between serebrovasculer diseases subtypes with 100% sensitivity and 91,1% specificity, when the cut-off point was accepted as 6,0 mm in mean optic nerve sheath diameter measurements by ocular ultrasonography. Conclusions: The increase in intracranial pressure in patients with serebrovasculer diseases can be easily detected by the ultrasonographic optic nerve sheath diameter measurement method. Ocular ultrasonography can guide the emergency physician in the differential diagnosis of ischemic/hemorrhagic stroke. Keywords: Stroke, Ultrasonography, Optic nerve sheath diameter