The current study aimed to identify whether ultrasonographic measurements of optic nerve sheath diameter (ONSD) could dynamically and sensitively evaluate real-time intracranial pressure (ICP). ONSD measurements were performed approximately 5  min prior to and after a lumbar puncture (LP). A total of 84 patients (mean±SD age, 43.5±14.7 years; 41 (49%) men; 18 patients with elevated ICP) were included in the study. The Spearman correlation coefficients between the two observers were 0.779 and 0.703 in the transverse section and 0.751 and 0.788 in the vertical section for the left and right eyes, respectively. The median (IQR) change in ONSD (ΔONSD) and change in ICP (ΔICP) were 0.11 (0.05–0.21) mm and 30 (20–40) mmH2O, respectively, for all participants. With a reduction in cerebrospinal fluid pressure, 80 subjects (95%) showed an immediate drop in ONSD; the median (IQR) decreased from 4.13 (4.02–4.38) mm to 4.02 (3.90–4.23) mm (p<0.001). Significant correlations were found between ONSD and ICP before LPs (r=0.482, p<0.01) and between ΔONSD and ΔICP (r=0.451, p<0.01). Ultrasonic measurement of ONSD can reflect the relative real-time changes in ICP.

BackgroundMigraine is considered as a risk factor for subclinical brain ischemic lesions, and right-to-left shunt (RLS) is more common among migraineurs. This cross-sectional study assessed the association of RLS with the increased prevalence of subclinical ischemic brain lesions in migraineurs.MethodsWe enrolled 334 migraineurs from a multicentre study from June 2015 to August 2016. Participants were all evaluated using contrast-enhanced transcranial Doppler, magnetic resonance imaging (MRI), and completed a questionnaire covering demographics, the main risk factors of vascular disease, and migraine status. RLS was classified into four grades (Grade 0 = Negative; Grade I = 1 ≤ microbubbles (MBs) ≤ 10; Grade II = MBs > 10 and no curtain; Grade III = curtain). Silent brain ischemic infarctions (SBI) and white matter hyperintensities (WMHs) were evaluated on MRI.ResultsWe found no significant differences between migraineurs with RLS and migraineurs without RLS in subclinical ischemic brain lesions.SBI and WMHs did not increase with the size of the RLS(p for trend for SBI = 0.066, p for trend for WMHs = 0.543). Furthermore, curtain RLS in migraineurs was a risk factor for the presence of SBI (p = 0.032, OR = 3.47; 95%CI: 1.12−10.76). There was no association between RLS and the presence of WMHs.ConclusionOverall, RLS is not associated with increased SBI or WMHs in migraineurs. However, when RLS is present as a curtain pattern, it is likely to be a risk factor for SBIs in migraineurs.Trial registrationNo. NCT02425696; registered on April 21, 2015.Electronic supplementary materialThe online version of this article (10.1186/s12883-018-1022-7) contains supplementary material, which is available to authorized users.

Background/Aims: Non-invasive measurement of intracranial pressure (ICP) using ultrasound has garnered increasing attention. This study aimed to compare the reliability of ultrasonographic measurement of optic nerve sheath diameter (ONSD) and transcranial Doppler (TCD) in detecting potential ICP elevations.Methods: Patients who needed lumbar puncture (LP) in the Department of Neurology were recruited from December 2016 to July 2017. The ONSD and TCD measurements were completed before LP.Results: One hundred sixty-five participants (mean age, 41.96 ± 14.64 years; 80 men; 29 patients with elevated ICP) were included in this study. The mean ICP was 170 ± 52 mmH2O (range, 75–400 mmH2O). Univariate analyses revealed that ICP was non-significantly associated with TCD parameters and significantly associated with ONSD (r = 0.60, P < 0.001). The mean ONSD of the elevated ICP group was significantly higher than that of the normal ICP group (4.53 ± 0.40 mm vs. 3.97 ± 0.23 mm; P < 0.001). Multivariate linear regression determined that the difference between ICP and ONSD is significant.Conclusions: In the early stage of intracranial hypertension, ONSD is more reliable for evaluating ICP than TCD.

To observe the changes of neutrophil gelatinase associated apolipoprotein (neutrophil gelatinase associated lipocalin), lipoprotein associated phospholipase A2 and inflammatory cytokine hypersensitive C-reactive protein in patients with coronary heart disease and to explore the correlation between serum lipoproteinassociated phospholipase A2, neutrophil gelatinase associated lipocalin, hypersensitive C-reactive protein and the degree of coronary artery disease in patients with coronary heart disease. 200 inpatients in cardiovascular department of our hospital were divided into coronary heart disease group (n=153) and control group (n=47) according to coronary angiography. The serum levels of lipoprotein-associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein were measured. According to the Gensini score, the patients in the CHD group were divided into mild, moderate, severe and extremely severe groups. The changes of serum lipoprotein associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein was analyzed. At the same time, the relationship between the levels of serum lipoprotein associated phospholipase A2, neutrophil gelatinase associated lipocalin, hypersensitive C-reactive protein and the degree of coronary artery disease was discussed from the three aspects of coronary artery stenosis and Gensini score and the value of combined detection in the diagnosis of coronary heart disease. The serum levels of lipoprotein associated phospholipase A2 lipoprotein associated phospholipase A2 , neutrophil gelatinase-associated lipocalin, hypersensitive C-reactive protein and Gensini score in the coronary heart disease group were significantly higher than those in the control group (p<0.01). The serum levels of lipoprotein-associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein in extremely severe coronary artery disease group were significantly higher than those in moderate to severe disease group, mild disease group and control group (p<0.05) and those in severe disease group were significantly higher than those in mild and moderate disease group and control group (p<0.05). The area under the curve of combined detection of lipoprotein-associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein in the diagnosis of coronary heart disease reached 0.859. The serum levels of lipoprotein associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein are significantly increased in patients with coronary heart disease and are closely related to the severity of coronary artery disease, which can be used to evaluate the severity of coronary artery disease. The diagnostic rate of combined detection of serum lipoprotein associated phospholipase A2, neutrophil gelatinase associated lipocalin and hypersensitive C-reactive protein for coronary heart disease can reach 0.859, which can ...

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