Effect of a cervical collar on optic nerve sheath diameter in trauma patients

BACKGROUND:As advocated in advanced trauma life support and prehospital trauma life support protocols,cervical immobilization is applied until cervical spine injury is excluded.This study aimed to show the difference in optic nerve sheath diameter(ONSD)between patients with and without a cervical collar using computed tomography(CT).METHODS:This was a single-center,retrospective study examining trauma patients who presented to the emergency department between January 1,2021,and December 31,2021.The ONSD on brain CT of the trauma patients was measured and analyzed to determine whether there was a difference between the ONSD with and without the cervical collar.RESULTS:The study population consisted of 169 patients.On CT imaging of patients with(n=66)and without(n=103)cervical collars,the mean ONSD in the axial plane were 5.43±0.50 mm and 5.04±0.46 mm respectively for the right eye and 5.50±0.52 mm and 5.11±0.46 mm respectively for the left eye.The results revealed an association between the presence of a cervical collar and the mean ONSD,which was statistically significant(P<0.001)for both the right and left eyes.CONCLUSION:A cervical collar may be associated with increased ONSD.The effect of this increase in the ONSD on clinical outcomes needs to be investigated,and the actual need for cervical collar in the emergency department should be evaluated on a case-by-case basis.

Optic nerve sheath diameters in nontraumatic brain injury:A scoping review and role in the intensive care unit

BACKGROUND Neuromonitoring in medical intensive care units is challenging as most patients are unfit for invasive intracranial pressure(ICP)modalities or unstable to transport for imaging.Ultrasonography-based optic nerve sheath diameter(ONSD)is an attractive option as it is reliable,repeatable and easily performed at the bedside.It has been sufficiently validated in traumatic brain injury(TBI)to be incorporated into the guidelines.However,currently the data for non-TBI patients is inconsistent for a scientific recommendation to be made.AIM To compile the existing evidence for understanding the scope of ONSD in measuring ICP in adult non-traumatic neuro-critical patients.METHODS PubMed,Google Scholar and research citation analysis databases were searched for studies in adult patients with non-traumatic causes of raised ICP.Studies from 2010 to 2024 in English languages were included.RESULTS We found 37 articles relevant to our search.The cutoff for ONSD in predicting ICP varied from 4.1 to 6.3 mm.Most of the articles used cerebrospinal fluid opening pressure followed by raised ICP on computed tomography/magnetic resonance imaging as the comparator parameter.ONSD was also found to be a reliable outcome measure in cases of acute ischaemic stroke,intracerebral bleeding and intracranial infection.However,ONSD is of doubtful utility in septic metabolic encephalopathy,dysnatremias and aneurysmal subarachnoid haemorrhage.CONCLUSION ONSD is a useful tool for the diagnosis of raised ICP in non-traumatic neuro-critically ill patients and may also have a role in the prognostication of a subset of patients.

Bedside ultrasonography of optic nerve sheath diameter for detection of raised intracranial pressure in nontraumatic neurocritically ill patients

BACKGROUND Delay in treatment of raised intracranial pressure(ICP)leads to poor clinical outcomes.Optic nerve sheath diameter(ONSD)by ultrasonography(US-ONSD)has shown good accuracy in traumatic brain injury and neurosurgical patients to diagnose raised ICP.However,there is a dearth of data in neuro-medical intensive care unit(ICU)where the spectrum of disease is different.AIM To validate the diagnostic accuracy of ONSD in non-traumatic neuro-critically ill patients.METHODS We prospectively enrolled 114 patients who had clinically suspected raised ICP due to non-traumatic causes admitted in neuro-medical ICU.US-ONSD was performed according to ALARA principles.A cut-off more than 5.7 mm was taken as significantly raised.Raised ONSD was corelated with raised ICP on radiological imaging.Clinical history,general and systemic examination findings,SOFA and APACHE 2 score and patient outcomes were recorded.RESULTS There was significant association between raised ONSD and raised ICP on imaging(P<0.001).The sensitivity,specificity,positive and negative predictive value at this cut-off was 77.55%,89.06%,84.44% and 83.82% respectively.The positive and negative likelihood ratio was 7.09 and 0.25.The area under the receiver operating characteristic curves was 0.844.Using Youden’s index the best cut off value for ONSD was 5.75 mm.Raised ONSD was associated with lower age(P=0.007),poorer Glasgow Coma Scale(P=0.009)and greater need for surgical intervention(P=0.006)whereas no statistically significant association was found between raised ONSD and SOFA score,APACHE II score or ICU mortality.Our limitations were that it was a single centre study and we did not perform serial measurements or ONSD pre-and post-treatment or procedures for raised ICP.CONCLUSION ONSD can be used as a screening a test to detect raised ICP in a medical ICU and as a trigger to initiate further management of raised ICP.ONSD can be beneficial in ruling out a diagnosis in a low-prevalence population and rule in a diagnosis in a high-prevalence population.

Sonographic Measurement of the Optic Nerve Sheath Diameter (ONSD) and Eyeball Transversal Diameter (ETD) in Benin Healthy African Adults

Background: Measuring optic nerve sheath diameter (ONSD), a relatively re-cent technique, allows an indirect and non-invasive diagnosis of intracranial hypertension. The ONSD ratio to eyeball transverse diameter (ETD) increases this reliability of the technique. The objective of this study was to determine the normal ONSD and its ratio with ETD in black African adults in Benin. Methods: A descriptive cross-sectional study was conducted between May 2019 and August 2019. Ultrasound ONSD and ONSD/ETD ratio were meas-ured in 210 healthy adults received in the medical imaging department of the Borgou and Alibori University Hospital Center in Benin. The ONSD corre-sponded to the average of 12 measurements (03 horizontal and 03 vertical for each eye) taken 3 mm behind the papilla. The transverse ETD corresponded to the average of 03 measurements. Results: The mean ONSD was 4.20 ± 0.28 mm (95% CI = [4.17;4.24] mm and 95th percentile = 4.70 mm). The mean ETD was 24.25 ± 1.10 mm. The ONSD/ETD ratio was 0.17 ± 0.01 (95% CI = [0.17;0.17] and 95th percentile = 0.19). There was no difference between ver-tical and horizontal ONSD and between right and left ONSD. The ONSD and the ONSD/ETD ratio were not correlated with any of the socio-demographic and anthropometric characteristics studied (sex, age, ethnicity, weight, height, body mass index, head circumference and waist circumference). The ONSD was associated with ETD (p < 0.001 and r = 0.55). Conclusion: An ONSD and an ONSD/ETD ratio respectively greater than 4.70 mm and 0.19 should sus-pect intracranial hypertension. The ONSD/ETD ratio may be a better indicator of HICT because of its small variation.

Prognostic values of optic nerve sheath diameter for comatose patients with acute stroke:An observational study

BACKGROUND Optic nerve sheath diameter(ONSD)measurement is one of the non-invasive methods recommended for increased intracranial pressure(ICP)monitoring.AIM This study aimed to evaluate the roles of optic nerve sheath diameter(ONSD)and ONSD/eyeball transverse diameter(ETD)ratio in predicting prognosis of death in comatose patients with acute stroke during their hospitalization.METHODS A total of 67 comatose patients with acute stroke were retrospectively recruited.The ONSD and ETD were measured by cranial computed tomography(CT)scan.All patients underwent cranial CT scan within 24 h after coma onset.Patients were divided into death group and survival group according to their survival status at discharge.The differences of the ONSD and ONSD/ETD ratio between the two groups and their prognostic values were compared.RESULTS The ONSD and ONSD/ETD ratio were 6.07±0.72 mm and 0.27±0.03 in the comatose patients,respectively.The ONSD was significantly greater in the death group than that in the survival group(6.32±0.67 mm vs 5.65±0.62 mm,t=4.078,P<0.0001).The ONSD/ETD ratio was significantly higher in the death group than that in the survival group(0.28±0.03 vs 0.25±0.02,t=4.625,P<0.0001).The area under the receiver operating characteristic curve was 0.760(95%CI:0.637-0.882,P<0.0001)for the ONSD and 0.808(95%CI:0.696-0.920,P<0.0001)for the ONSD/ETD ratio.CONCLUSION The mortality increased in comatose patients with acute stroke when the ONSD was>5.7 mm or the ONSD/ETD ratio was>0.25.Both indexes could be used as prognostic tools for comatose patients with acute stroke.The ONSD/ETD ratio was more stable than the ONSD alone,which would be preferred in clinical practice.

Sonographic Measurement of Optic Nerve Sheath Diameter: A Prognostic Tool for Childhood Cerebral Malaria?

Background: Childhood cerebral malaria is one of the most frequent complications of malaria, with high morbidity and mortality. Raised Intracranial Pressure (ICP) is currently recognized as a fundamental element of the severity of that disease. This study aims to look into the prognostic role of the sonographic measurement of optic nerve sheath diameter (ONSD) in the context of that disease. Methods: This study was conducted in the pediatric and imaging departments of the University Hospital Center of Parakou in Republic of Benin in West Africa. This was a descriptive cross-sectional study with a prospective data collection conducted over a period of 6 months, from March 1st to August 31st, 2014. There were two groups of children with severe malaria and conscious impairment: one with unrousable coma or Cerebral Malaria (Group 1) and the other without unrousable coma (Group 2), benefitting from ONSD sonographic measurement. ONSD was measured 3 mm behind the papilla. Correlation between depth of coma, outcome and ONSD measure on ultrasound was investigated. Results: Group 1 consisted of 37 children and Group 2 of 50 children, i.e. a sample of 87 children. The mean age was 27.21 ± 20.11 months and sex ratio (Male/Female) estimated at 0.89. The average ONSD of the sample was 4.39 ± 0.94 mm with a significant difference (p = 0.0001) between Group 1 (5.09 ± 1.09 mm) and Group 2 (3.87 ± 0.17 mm). Raised ICP prevalence was 48.28% with a significant difference between Group 1 (83.78%) and Group 2 (22%) with p Conclusion: Sonographic measurement of ONSD could be a leading prognostic tool in childhood cerebral malaria management.

The clinical value of dynamic ultrasound measurement of optic nerve sheath diameter in the treatment of patients with moderate and severe craniocerebral injury

Objective:To explore the clinical value of dynamic ultrasound monitoring of optic nerve sheath diameter(ONSD)in the treatment of patients with moderate and severe head injury(CI).Methods:A total of 160 patients with moderate and severe CI admitted to the First Affiliated Hospital of Hainan Medical University from January 2018 to January 2020 were selected and divided into observation group(80 cases)and control group(80 cases)a Januaryccording to the random number table.Patients in control group and observation group were dehydrated to reduce intracranial pressure(ICP)according to clinical symptoms/brain CT and ONSD monitoring guidance.National Institutes of Health Stroke Scale(NIHSS),Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ),Glasgow Coma Scale(GCS),complications,prognosis,ICU stay time and mechanical ventilation time were compared between the two groups.Results:NIHSS score[control group:(19.58±3.19)points vs(37.98±5.75)points,observation group:(10.33±2.42)points vs(38.05±5.83)points]and APACHE II score[control group:(14.55±2.17)points vs(19.87±3.50)points,observation group:(8.71±2.03)points vs(20.12±3.56)points]of the two groups at 1 month after injury were significantly lower than those at admission(P<0.05),GCS score[control group:(10.78±1.66)points vs(8.03±1.34)points,observation group:(13.10±1.72)points vs(7.99±1.32)points]were significantly higher than that at admission(P<0.05).At 1 month after injury,NIHSS score[(10.33±2.42)points vs(19.58±3.19)points],APACHE II score[(8.71±2.03)points vs(14.55±2.17)points]in the observation group were significantly lower than those in the control group(P<0.05),and GCS score[(13.10±1.72)points vs(10.78±1.66)points]in the observation group was significantly higher than that in the control group(P<0.05).The proportion of hydrocephalus(2.50%vs 12.50%),total complication rate(5.00%vs 21.25%),proportion of severe disability(5.00%vs 17.50%),proportion of survival in plant man(3.75%vs 15.00%),mortality rate(2.50%vs 12.50%),ICU stay time[(5.01±1.25)d vs(8.38±2.29)D],mechanical ventilation time[(2.18±0.75)D]in observation group were lower than those in the control group,and the good rate(56.25%vs 32.50%)and the total effective rate(93.75%vs 72.50%)in the control group were significantly higher than those in the control group(P<0.05).Conclusion:Dynamic ultrasound monitoring ONSD is effective in guiding dehydration treatment of patients with moderate and severe CI,it can significantly reduce ICP and complications,improve prognosis,which is worthy of promotion and application.

Military trainees can accurately measure optic nerve sheath diameter after a brief training session

Background: Identification of elevated intracranial pressure is important following traumatic brain injury. We assessed the feasibility of educating military trainees on accurately obtaining optic nerve sheath diameter measurements using a brief didactic and hands-on training session. Optic nerve sheath diameter is a noninvasive surrogate marker for elevated intracranial pressure, and may be of value in remote military operations, where rapid triage decisions must be made without access to advanced medical equipment.Methods: Military trainees with minimal ultrasound experience were given a 5-min didactic presentation on optic nerve sheath diameter ultrasound. Trainees practiced optic nerve sheath diameter measurements guided by emergency physician ultrasound experts. Trainees then measured the optic nerve sheath diameter on normal volunteers. Following this, a trained physician measured the optic nerve sheath diameter on the same volunteer as a criterion standard. An average of three measurements was taken.Results: Twenty-three military trainees were enrolled. A mixed design ANOVA was used to compare measurements by trainees to those of physicians, with a mean difference of –0.6 mm(P=0.76). A Bland-Altman analysis showed that the degree of bias in optic nerve sheath diameter measures provided by trainees was very small: d=–0.004 for the right eye and d=–0.007 for the left eye.Conclusions: This study demonstrates that optic nerve sheath diameter measurement can be accurately performed by novice ultrasonographers after a brief training session. If validated, point-of-care optic nerve sheath diameter measurement could impact the triage of injured patients in remote areas.

Ocular ultrasound evaluation of optic nerve sheath diameter in military environments

In this letter to the Editor, we would like to comment on the article by Betcher et al., concerning the possibility of teaching military trainees to obtain accurate optic nerve sheath diameter measurements, using a brief didactic and a hands-on training session. In particular, this letter notes the importance of the measurement of optic nerve sheath diameter in detecting the eventual elevated intracranial pressure following traumatic brain injury, highlights several limitations in the use of B-scan for such a purpose and suggests a more accurate evaluation with the standardized A-scan.

超声ONSD联合TCCD脑中线移位为基础的无创多模态颅内压监测在大面积脑梗死救治中的应用价值

目的 探讨超声视神经鞘直径(ONSD)联合经颅彩色多普勒超声(TCCD)脑中线移位为基础的无创多模态颅内压监测在大面积脑梗死患者救治中的应用价值。方法 选取2021年3月—2023年3月宿迁市钟吾医院确诊的大脑半球大面积脑梗死患者80例,随机分为对照组(n=40,常规监测)和研究组(n=40,常规监测+超声多模态监测)。对比2组患者一般资料、行去骨瓣减压术比例和术后6个月格拉斯哥预后评分(GOS)。多因素logistic回归分析ONSD、TCCD脑中线移位监测值与去骨瓣减压术的关系。用受试者工作特征(ROC)曲线分析预测价值。结果 2组行去骨瓣减压术比例差异无统计学意义(P>0.05),研究组患者术前住院时间明显少于对照组,术后6个月GOS评分明显高于对照组(P<0.05);研究组行去骨瓣减压术患者超声ONSD、TCCD脑中线移位值高于保守治疗患者(P<0.05);超声ONSD、TCCD脑中线移位、二者联合预测大面积脑梗死患者行去骨瓣减压术的曲线下面积(AUC)分别为0.854、0.748、0.891。结论 以超声ONSD、TCCD为基础的无创多模态颅内压监测可以较为准确地预测大面积脑梗死患者行去骨瓣减压术,测量结果可信度较高,有助于改善预后,值得在临床推广使用。

脑血流超声、ONSD评估CPR患者神经功能的临床价值

目的探讨脑血流超声联合视神经鞘直径(ONSD)评估心肺复苏(CPR)患者神经功能的临床价值。方法选取行CPR术后昏迷患者100例,根据预后分为预后良好组和预后不良组。比较两组临床资料、术后脑脊液压力以及术后1、3、7天超声参数。分析脑脊液压力与超声参数的相关性、影响CPR患者神经功能预后的因素以及超声参数评估CPR患者神经功能预后的价值。结果与预后良好组比较,预后不良组CPR时间、机械通气时间增加;院内心脏骤停占比降低、术后1天搏动指数(PI)、阻力指数(RI)、术后3、7天ONSD、PI、RI升高;术后1天平均血流速度(Vm)、术后3、7天收缩期血流速度(Vs)、舒张期末血流速度(Vd)、Vm降低;术后脑脊液压力升高(P<0.05)。术后脑脊液压力与ONSD、RI、PI、Vm均具相关性(P<0.05)。CPR时间、脑脊液压力、ONSD、RI、PI、Vm是神经功能预后的独立影响因素(P<0.05)。术后3天双侧ONSD、Vm、RI、PI对CPR患者神经功能预后具有良好的预测价值(P<0.05)。结论超声动态监测脑血流和ONSD可有效评估CPR患者神经功能预后。

Increase in optic nerve sheath diameter predicts early cerebral involvement in fat embolism syndrome

Early diagnosis of cerebral fat embolism in a patient with contradiction to MRI is challenging.Here we report an interesting case,where the raised optic nerve sheath diameter helped us to predict the early cerebral involvement with fat emboli in a left femoral shaft fracture patient.MRI scan could not be performed due to the presence of a metallic implant in the patient from a previous surgery.He was later diagnosed as an atypical presentation of fat embolism syndrome.Optic nerve sheath monitoring also helped us to guide further management of the patient.

全凭静脉麻醉对重度子痫前期产妇ONSD、血流动力学及新生儿的影响

目的 探讨全凭静脉麻醉对重度子痫前期产妇视神经鞘直径(ONSD)、血流动力学及新生儿的影响。方法 选择2019年11月—2022年7月收治重度子痫前期产妇108例,按照麻醉方式不同分为观察组56例和对照组52例。观察组采用全凭静脉麻醉,对照组采用硬膜外麻醉。对比2组手术相关指标、ONSD、血流动力学[收缩压(SBP)、舒张压(DBP)、MAP、心率]及新生儿Apgar评分、插管率。结果 观察组麻醉诱导时间、胎儿娩出时间均短于对照组(P<0.01)。观察组麻醉后5 min、胎儿娩出后5 min、术毕30 min ONSD小于麻醉前和对照组(P<0.05);观察组术毕30 min DBP高于对照组,麻醉后5 min、胎儿娩出后5 min、术毕30 min心率快于对照组(P<0.05)。观察组新生儿5 min Apgar评分高于对照组(P<0.01)。观察组新生儿插管率(8.92%,5/56)与对照组(11.53%,6/52)比较差异无统计学意义(P>0.05)。结论 全凭静脉麻醉较硬膜外麻醉有利于改善重度子痫前期产妇ONSD,可显著降低产妇颅内压,且对血流动力学及新生儿影响更小。

经颅多普勒超声及超声测量视神经鞘直径在颅脑损伤患者颅内压增高中的应用价值

目的探索经颅多普勒超声(Transcranial Doppler Ultrasound,TCD)及超声测量视神经鞘直径(Optic Nerve Sheath Diameter,ONSD)在颅脑损伤患者颅内压增高中的应用价值。方法回顾性分析2021年1月至2022年12月160例颅脑损伤患者的临床资料,根据是否存在颅内压增高分为观察组(n=80)与对照组(n=80),均进行TCD、ONSD测量,比较两组ONSD、TCD参数,分析颅内压增高与ONSD、TCD参数的相关性。建立受试者工作特征(Receiver Operating Characteristic,ROC)曲线模型,分析ONSD值、平均血流速度(Mean Velocity,Vm)、收缩期峰血流速度(Systolic Peak Flow Velocity,Vs)、阻力指数(Resistance Index,RI)、搏动指数(Pulse Index,PI)诊断效能。结果观察组ONSD值(5.44±1.16)mm、RI(0.77±0.21)、PI(2.32±1.18)高于对照组,Vs(112.58±26.63)cm/s、Vm(48.83±18.96)cm/s低于对照组(P<0.05);重度组ONSD值(6.16±1.13)mm、RI(0.90±0.21)、PI(3.63±1.25)高于中度组、轻度组,Vs(100.83±30.80)cm/s、Vm(30.71±13.36)cm/s低于中度组、轻度组(P<0.05)。颅内压增高与ONSD值、RI、PI呈正相关性(r=0.517、0.569、0.652;P<0.001),与Vs、Vm呈负相关性(r=-0.340、-0.703;P<0.001);经ROC曲线分析,ONSD值、Vs、Vm、RI、PI及联合诊断重度颅内压增高的曲线下面积分别为0.806、0.670、0.921、0.809、0.960、0.996。结论TCD、ONSD对评估颅脑损伤患者颅内压变化有着积极意义,超声频谱图像能够直观反映颅内压变化情况,ONSD值可因颅内压增高而改变。

基于头颅CT的视神经鞘直径在颅内静脉窦血栓形成诊断和预后评估中的价值

目的 评价薄层头颅CT平扫图像上测得的视神经鞘直径(ONSD)在颅内静脉窦血栓形成(CVST)诊断和预后评估中的应用价值。方法 回顾性分析2016年1月1日至2022年12月31日在南京医科大学第一附属医院接受治疗的CVST患者临床资料。比较CVST患者与正常人群ONSD差异及治疗前后ONSD变化。结果 共纳入CVST患者49例(CVST组)及49例无脑疾患正常人(对照组)。CVST组治疗前综合ONSD显著高于对照组[(5.33±0.50) mm比(4.40±0.40) mm,P<0.01],治疗后显著下降[(4.98±0.59) mm,P<0.01]。单纯抗凝治疗患者治疗前后综合ONSD变化值与血管内治疗患者相比,差异无统计学意义[(-0.43±0.22) mm比(-0.40±0.42) mm,P=0.84]。伴脑出血患者、无脑出血患者治疗前综合ONSD分别为(5.26±0.51)mm、(5.41±0.49) mm(P=0.31),治疗前后综合ONSD变化值差异无统计学意义[(-0.39±0.40) mm比(-0.45±0.25) mm,P=0.66]。3个月随访时预后良好(mRS评分0~2分)患者与预后不良患者综合ONSD相比,差异无统计学意义(P>0.05)。结论 头颅CT平扫图像上测得的ONSD可作为CVST患者颅内压升高的反应指标,可能用于监测治疗前后颅内压变化,但在评价不同治疗方法疗效方面的意义尚需进一步探索。

非小细胞肺癌软脑膜转移患者MR测量与脑脊液压力的相关性研究

目的:探讨非小细胞肺癌(non-small cell lung cancer,NSCLC)软脑膜转移(leptomeningeal metastases,LM)患者磁共振(magnetic resonance,MR)测量视神经鞘直径(optic nerve sheath diameter,ONSD)和头颅外周脑脊液体积/全脑容积(peripheral cerebrospinal fluid volume/intracranial volume,PCSFV/ICV)比值与脑脊液压力(cerebrospinal fluid pressure,CSFP)的相关性,评估ONSD和PCSFV/ICV联合诊断CSFP升高的准确性。方法:共收集63例NSCLC-LM患者,所有患者同时进行视神经和颅脑MR扫描,测量双眼ONSD、颅脑PCSFV和ICV。随后对所有患者行腰椎穿刺测量CSFP,并定期进行鞘内化疗。采用Pearson相关分析法分析CSFP与MR表现的相关性。通过受试者工作特征(receiver operating characteristic,ROC)曲线评估ONSD和PCSFV/ICV联合诊断CSFP升高的准确性。结果:所有NSCLC-LM患者双眼平均ONSD与CSFP呈正相关(r=0.567,P<0.001),PCSFV/ICV与CSFP呈负相关(r=-0.365,P=0.003)。ROC曲线分析显示ONSD、PCSFV/ICV及ONSD联合PCSFV/ICV诊断颅内高压(CSFP>15 mmHg)的性能分别为0.81(95%CI:0.71~0.91)、0.76(95%CI:0.64~0.89)和0.91(95%CI:0.84~0.99)。ONSD、PCSFV/ICV及ONSD联合PCSFV/ICV诊断颅内高压(CSFP>20 mmHg)的性能分别为0.70(95%CI:0.58~0.82)、0.72(95%CI:0.57~0.88)和0.81(95%CI:0.70~0.93)。结论:经MR测量ONSD和PCSFV/ICV可以评估NSCLC-LM患者CSFP的变化,二者联合能够提高诊断颅内高压的准确性,有较好的临床应用价值。

特发性高颅压临床特点和超声表现分析

目的分析特发性高颅压(idiopathic intracranial hypertension,IIH)的临床特点,以及归纳梳理相关的超声表现。方法回顾性连续纳入2021年7月—2023年6月在首都医科大学宣武医院急诊神经内科住院的IIH患者32例。收集患者的基线资料(年龄、性别、身高、BMI、颅内压)、临床表现、MRV或DSA及超声检查的各项参数(颈内静脉的内径及流量、视神经鞘直径、视盘高度等),对数据进行分析和总结。结果①本研究共入组32例患者,年龄(32.0±10.6)岁,男女比例9∶23,身高(162.0±8.3)cm,BMI 27.5(24.0~31.8)kg/m^(2),颅内压330.0(300.0~396.3)mmHg(1 mmHg=0.133 kPa)。②入组患者的临床表现为头痛16例(50.0%)、视物模糊16例(50.0%)、恶心/呕吐12例(37.5%)、头晕6例(18.8%)、耳鸣/脑鸣6例(18.8%)。③入组的32例患者中,合并糖尿病16例(50.0%)、高脂血症13例(40.6%)、高血压7例(21.9%)、阻塞性睡眠呼吸暂停综合征4例(12.5%)、自发性脑脊液漏2例(6.3%);入组的23例女性患者中,合并多囊卵巢综合征5例(21.7%)。④超声测量入组患者的视神经鞘直径4.92(4.90~5.09)mm,视盘高度0.83(0~1.28)mm。⑤MRV或DSA结果显示,颅内静脉窦狭窄共7例(21.9%),其中右侧颅内静脉窦狭窄5例(15.6%),左侧颅内静脉窦狭窄2例(6.3%)。⑥颅内静脉窦非狭窄组中,右侧颈内静脉J2、J3段内径大于左侧颈内静脉J2、J3段内径[(6.48±1.69)mm vs.(5.63±1.10)mm,P=0.006;(4.62±1.44)mm vs.(3.42±0.88)mm,P<0.001],右侧颈内静脉J2、J3段流量大于左侧颈内静脉J2、J3段流量[(376.8±172.8)mL/min vs.(229.6±93.3)mL/min,(214.4±104.0)mL/min vs.(115.2±62.9)mL/mi n,均P<0.001];颅内静脉窦狭窄组中,狭窄侧颈内静脉J3段内径小于健侧内径([3.23±1.05)mm vs.(3.99±1.25)mm,P=0.011],狭窄侧颈内静脉J3段流量小于健侧流量([91.4±68.7)mL/min vs.(192.9±87.9)mL/min,P=0.004]。结论结果显示,IIH与肥胖密切相关,且伴较高的多囊卵巢综合征、自发性脑脊液漏、阻塞性睡眠呼吸暂停综合征、高血压、高脂血症、糖尿病、颅内静脉窦狭窄发病率。同时,颅内静脉窦狭窄侧J3段颈内静脉内径及流量均小于健侧。IIH引起视神经鞘直径的增宽和视盘高度的增高。

动脉瘤性蛛网膜下腔出血患者视神经鞘直径与颅内压的相关性

目的探索动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者术后视神经鞘直径(optic nerve sheath diameter,ONSD)与颅内压(intracranial pressure,ICP)的相关性。方法纳入2019年12月1日至2022年6月1日收治在首都医科大学附属北京天坛医院重症医学科的aSAH术后且行ICP监测及头颅电子计算机断层扫描(computed tomography,CT)检查患者,通过CT测量ONSD并记录ICP数值,利用组内相关系数(intraclass correlation coefficient,ICC)评价3名研究者测量ONSD的一致性,采用Spearman相关系数评价ONSD与ICP的相关性。结果纳入184名aSAH术后患者共282例次ONSD数值以及对应的ICP,ICP的中位数是12(9,18)mmHg(1 mmHg=0.133 kPa);ONSD的中位数是5.59(5.26,5.99)mm。3名不同研究者测量双侧ONSD的ICC分别为0.895(0.872~0.915,P<0.001)、0.869(0.841~0.894,P<0.001)。ONSD和ICP呈正相关(r=0.273,95%CI:0.158~0.381,P<0.001)。ONSD预测ICP>22 mmHg的曲线下面积为0.753(95%CI:0.670~0.836,P<0.001),cutoff值为5.61 mm,灵敏度、特异度分别为85.2%、55.3%。结论应用CT测量ONSD具有可重复性,其与有创ICP数值显著相关。

右美托咪定对腹腔镜下妇科恶性肿瘤根治术患者视神经鞘直径的影响

目的探讨右美托咪定对腹腔镜下妇科恶性肿瘤根治术患者视神经鞘直径(ONSD)的影响。方法本研究为单中心、前瞻性、随机、双盲、对照临床试验。纳入2022-11至2023-06在解放军总医院第七医学中心行腹腔镜下妇科恶性肿瘤根治术的患者62例,采用随机数字表法分为试验组和对照组,每组31例。两组患者麻醉诱导方案一致,试验组麻醉诱导后静脉给予右美托咪定负荷剂量1μg/kg,持续泵注10 min,然后以0.4μg/(kg·h)持续泵注至手术结束前30 min;对照组给予等容量生理盐水。记录患者的年龄、身高、体重、ASA分级、麻醉时间、手术时间、输液量、出血量、拔管时间、住院时间;测量两组患者麻醉诱导后(T_(0))、泵入右美托咪定负荷剂量后(T_(1))、气腹10 min(T_(2))、30 min(T_(3))、1 h(T_(4))、2 h(T_(5))、3 h(T_(6))及改回平卧位并关闭气腹后10 min(T_(7))各时点的ONSD、平均动脉压(MAP)、心率(HR);并记录两组患者术中发生心动过缓、术后3 h内恶心呕吐及头痛的发生情况。结果试验组T_(2)至T_(7)时点的ONSD均小于对照组,差异有统计学意义(P<0.05)。试验组T_(1)、T_(3-6)时点的MAP高于对照组,差异有统计学意义(P<0.05)。试验组T_(1),T_(5-7)时点的HR低于对照组,差异有统计学意义(P<0.05)。试验组术后3 h内头痛的发生率为3.2%(1/31),低于对照组的29.0%(9/31),差异有统计学意义(P<0.05)。结论右美托咪定可有效减缓腹腔镜下妇科恶性肿瘤根治术患者ONSD的增加,降低术后头痛的发生率。

超声参数ONSD对颅脑损伤患者颅内压增高的诊断价值

目的探究超声参数视神经鞘直径(Optic Nerve Sheath Diameter,ONSD)对颅脑损伤患者颅内压(Intracranial Pressure,ICP)增高的诊断价值。方法选取2019年4月至2020年4月我院收治的109例颅脑损伤患者作为研究对象,按照其ONSD值将其分为ICP正常组42例、ICP可疑升高组36例、ICP升高组31例。对颅脑损伤患者进行超声测量ONSD检查,以ONSD≥5.3 mm为阈值判断患者ICP是否升高。结果ICP升高组ONSD值高于ICP可疑升高组,具有统计学差异(P<0.05);三组患者眼球横径值对比显示差异无统计学意义(P>0.05);ONSD法诊断ICP升高的诊断价值较高,具有统计学差异(P<0.05);ICP升高组预后情况优于ICP可疑升高组,具有统计学差异(P<0.05)。ONSD预测ICP的ROC曲线下面积为0.897(0.821~0.936),灵敏度为86.59%,特异度为82.34%,准确度为91.25%。结论超声测量ONSD可实时、动态地预测颅脑损伤患者ICP增高的变化情况,敏感度、特异度较高,具有较高的预测价值。