The Prognostic Value of Optic Nerve Sheath Diameter in Patients with Poor-Grade Subarachnoid Hemorrhages

Abstract

We evaluated if the optic nerve sheath diameter (ONSD) on brain computed tomography (CT) could be used to predict neurological outcomes of patients with poor-grade subarachnoid hemorrhage (SAH). Methods This was a retrospective and observational study of adult patients with poor-grade SAH admitted January 2012 through June 2017. Initial brain CT was performed within 12 hours from onset of SAH. Follow-up brain CT was performed within 48 hours from onset of SAH and after aneurysmal treatment. The primary outcome was neurological status upon six months later assessed with Glasgow Outcome Scale (GOS, 1 to 5). Results Among 59 patients with poor-grade SAH, survival to discharge was identified in 47 (79.7%) patients. Of these 47 survivors, 39 (66.1%) had good neurological outcomes (GOS of 3, 4 or 5). In this study, initial ONSDs and follow-up ONSDs in the poor neurological outcome group were significantly greater than those in the good neurological outcome group (all p<0.03). The intracranial pressure (ICP) was monitored in only 13 (22.0%) patients at that time of follow-CT scanning. Using simple correlation analysis, there was a linear correlation between ONSD and ICP (ρ=0.683, p=0.010). In ROC curve analysis for prediction of poor neurological outcome, ONSDs and ONSD indices had considerable predictive values (C-statistics: 0.683 to 0.804) and similar predictive performances for poor neurological outcome. Conclusion The ONSDs and ONSD indices measured on CT scanning may be beneficial for predicting neurological outcomes in patients with poor-grade SAH.

Subarachnoid hemorrhage–induced out-of-hospital cardiac arrest patients with ST-segment elevation from the electrocardiogram: Two case reports

“…1 In recent years, sonograms have played an important role in diagnosis in patients such as these, and the diameter of the optic nerve sheath may also imply a diagnosis of SAH. 12 In this report, we presented two cases of SAH-induced OHCA with ST-segment elevation on ECG. By sharing these two cases, we urge clinicians to consider SAH as a cause of cardiac arrest.…”

“…Parameters such as the female gender, a young age, and lack of comorbidities, headache or neurological signs prior to cardiac arrest, plus asystole or pulseless electrical activity as the initial rhythm, are common characteristics among SAH‐induced OHCA patients 1 . In recent years, sonograms have played an important role in diagnosis in patients such as these, and the diameter of the optic nerve sheath may also imply a diagnosis of SAH 12 . In this report, we presented two cases of SAH‐induced OHCA with ST‐segment elevation on ECG.…”