Prospective analysis of optic nerve diameter and NSE values in patients with resistant headache

Objective: In our thesis study, in patients with refractory headaches who applied to emergency medicine clinics, in addition to classical diagnostic studies, the findings of neuron damage and intracranial pressure increase were evaluated by ultrasonographic measurement of optic nerve diameter and NSE in plasma, We aimed to obtain data to facilitate the hospitalization decision. Material and Method: Our study was conducted between December 2017 and June 2020, after approval by the local ethics committee of Çukurova University Faculty of Medicine. Patients over 18 years of age who were admitted to the emergency room due to headache resistant were included in our study. Patients with central nervous system disease (known intracranial mass, known pseudotumor cerebri, etc.) that could create known resistant headache at the time of admission to the emergency room were excluded from the study. The demographic data of the patients were recorded. In addition to the examinations and imaging used to investigate the causes of headache secondary causes, optic nerve diameter was measured with bedside USG to evaluate the patient's intracranial pressure increase. Neuron-specific enolase was evaluated in plasma for the detection of neuron damage. Diagnosis, length of stay, and outcome of patients were recorded. Results: A total of 66 patients, 33 male and 33 female, were included in our study. The mean age of the patients participating in the study was 43.05 ± 17.06. The primary and secondary causes of resistant headache were investigated. Secondary cause was detected in 45 (68.2%) of the patients. When ultrasonographic optic nerve diameter was evaluated, it was determined that 17 (25.8%) of the patients were right and 21 (31.8%) of the left optic nerve diameter was over 5 mm. With increasing left optic nerve diameter; It was determined that there was a positive correlation between NSE, lactate, AST and WBC values. Patients with optic nerve diameter of 5 mm and above were found to have a significantly higher duration of hospitalization. The NSE values of the patients who were decided to be hospitalized were significantly higher than the patients who were discharged. Conclusion: It is important to recognize secondary causes that may be life-threatening in patients with resistant headaches. Intracranial pressure increase can be detected by ultrasonographic optic nerve diameter measurement. Increasing plasma NSE levels are helpful in evaluating neuron damage.