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Transorbital Ultrasonographic Measurement of Optic Nerve Sheath Diameter in Brain Death.
J Neuroimaging. 2015 Nov-Dec; 25(6):906-9.JN

Abstract

BACKGROUND

Ultrasonographic measurement of optic nerve sheath diameter (ONSD) can successfully be used to estimate intracranial pressure (ICP) elevation. Its utility in corroboration of brain death (BD) was herein studied.

METHODS

ONSD was measured in 29 subjects with BD; in 19 comatose patients (with raised ICP in 11), 20 patients with various neurological diseases, and 40 healthy control subjects. The distance between the inner and outer edges of the echolucent lines around hyperechoic area surrounding the optic nerve (ON) was identified as ONSD external (ONSDe) and ONSD internal (ONSDi).

RESULTS

Compared to patients with neurological diseases (5.75 ± .79 mm) or healthy controls (5.98 ± .63 mm), ONSDe was significantly higher in comatose patients (7.61 ± .97 and 6.71 ± 1.07 mm in those with and without raised ICP) and BD subjects (8.34 ± .66 mm). ONSDi showed similar trends across the groups: 6.09 ± .71 mm in BD; 5.89 ± .37 mm in comatose control with elevated ICP; 5.16 ± .49 mm in comatose control with normal ICP; 4.36 ± .68 mm in neurological control; 4.69 ± .67 mm in healthy control. The accuracy of ONSDe measurements in differentiating patients with ICP elevation (n = 40) was .965 as determined by area under the curve (AUC) of receiver-operator characteristics curves. Similarly, accuracy in discrimination of BD was .952. However, ONSDe showed limited yield to identify BD cases among comatose patients with Glasgow coma scale score of 3, where accuracy was .803 (95% CI: .709-.816) and decreased further to .722 (95% CI: .610-.816) when analyses were restricted to comatose patients with ICP elevation. AUC values for ONSDi was similar or lower.

CONCLUSION

ONSD is significantly greater in subjects with BD. However, quantification of ONSD cannot discriminate BD subjects from comatose ones with raised ICP with 100% certainty.

Authors+Show Affiliations

Department of Neurology and Neurological Intensive Care Unit, Hacettepe University Hospitals, Sihhiye, Ankara, Turkey.Department of Neurology and Neurological Intensive Care Unit, Hacettepe University Hospitals, Sihhiye, Ankara, Turkey.Department of Neurology and Neurological Intensive Care Unit, Hacettepe University Hospitals, Sihhiye, Ankara, Turkey. Department of Neurology, OsmanGazi University Medical Faculty Hospital, Meselik, Eskisehir, Turkey.Department of Neurology and Neurological Intensive Care Unit, Hacettepe University Hospitals, Sihhiye, Ankara, Turkey. Department of Neurology, Necmettin Erbakan University, Meram Medical Faculty Hospital, Konya, Turkey.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25800801

Citation

Topcuoglu, Mehmet A., et al. "Transorbital Ultrasonographic Measurement of Optic Nerve Sheath Diameter in Brain Death." Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging, vol. 25, no. 6, 2015, pp. 906-9.
Topcuoglu MA, Arsava EM, Bas DF, et al. Transorbital Ultrasonographic Measurement of Optic Nerve Sheath Diameter in Brain Death. J Neuroimaging. 2015;25(6):906-9.
Topcuoglu, M. A., Arsava, E. M., Bas, D. F., & Kozak, H. H. (2015). Transorbital Ultrasonographic Measurement of Optic Nerve Sheath Diameter in Brain Death. Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging, 25(6), 906-9. https://doi.org/10.1111/jon.12233
Topcuoglu MA, et al. Transorbital Ultrasonographic Measurement of Optic Nerve Sheath Diameter in Brain Death. J Neuroimaging. 2015 Nov-Dec;25(6):906-9. PubMed PMID: 25800801.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transorbital Ultrasonographic Measurement of Optic Nerve Sheath Diameter in Brain Death. AU - Topcuoglu,Mehmet A, AU - Arsava,E Murat, AU - Bas,D Funda, AU - Kozak,Hasan H, Y1 - 2015/03/19/ PY - 2014/08/03/received PY - 2015/01/24/revised PY - 2015/02/02/accepted PY - 2015/3/25/entrez PY - 2015/3/25/pubmed PY - 2016/12/15/medline KW - Diagnosis KW - brain death KW - optic nerve sheath diameter KW - raised intracranial pressure KW - specificity SP - 906 EP - 9 JF - Journal of neuroimaging : official journal of the American Society of Neuroimaging JO - J Neuroimaging VL - 25 IS - 6 N2 - BACKGROUND: Ultrasonographic measurement of optic nerve sheath diameter (ONSD) can successfully be used to estimate intracranial pressure (ICP) elevation. Its utility in corroboration of brain death (BD) was herein studied. METHODS: ONSD was measured in 29 subjects with BD; in 19 comatose patients (with raised ICP in 11), 20 patients with various neurological diseases, and 40 healthy control subjects. The distance between the inner and outer edges of the echolucent lines around hyperechoic area surrounding the optic nerve (ON) was identified as ONSD external (ONSDe) and ONSD internal (ONSDi). RESULTS: Compared to patients with neurological diseases (5.75 ± .79 mm) or healthy controls (5.98 ± .63 mm), ONSDe was significantly higher in comatose patients (7.61 ± .97 and 6.71 ± 1.07 mm in those with and without raised ICP) and BD subjects (8.34 ± .66 mm). ONSDi showed similar trends across the groups: 6.09 ± .71 mm in BD; 5.89 ± .37 mm in comatose control with elevated ICP; 5.16 ± .49 mm in comatose control with normal ICP; 4.36 ± .68 mm in neurological control; 4.69 ± .67 mm in healthy control. The accuracy of ONSDe measurements in differentiating patients with ICP elevation (n = 40) was .965 as determined by area under the curve (AUC) of receiver-operator characteristics curves. Similarly, accuracy in discrimination of BD was .952. However, ONSDe showed limited yield to identify BD cases among comatose patients with Glasgow coma scale score of 3, where accuracy was .803 (95% CI: .709-.816) and decreased further to .722 (95% CI: .610-.816) when analyses were restricted to comatose patients with ICP elevation. AUC values for ONSDi was similar or lower. CONCLUSION: ONSD is significantly greater in subjects with BD. However, quantification of ONSD cannot discriminate BD subjects from comatose ones with raised ICP with 100% certainty. SN - 1552-6569 UR - https://www.unboundmedicine.com/medline/citation/25800801/Transorbital_Ultrasonographic_Measurement_of_Optic_Nerve_Sheath_Diameter_in_Brain_Death_ L2 - https://doi.org/10.1111/jon.12233 DB - PRIME DP - Unbound Medicine ER -