Computed Tomography Measurement of Optic Nerve Sheath Diameter in Thrombolysis-Treated Ischemic Stroke: Association with Post-Thrombolytic Intracranial Hemorrhage.

Optic nerve sheath diameter (ONSD) measurement is a non-invasive marker of intracranial pressure. Its role in predicting post-thrombolytic intracranial hemorrhage in acute ischemic stroke patients remains unclear. This study aimed to evaluate whether baseline ONSD can predict intracranial hemorrhage after intravenous thrombolysis and to compare pre- and post-treatment ONSD values in patients with and without hemorrhage. This retrospective, single-center, observational study included acute ischemic stroke patients who received intravenous thrombolysis. ONSD was measured on admission (baseline) and at 24 h on axial non-contrast CT scans, 3 mm behind the globe. The delta ONSD (24 h - baseline) was calculated. Groups with and without post-thrombolytic hemorrhage were compared. A total of 235 patients were analyzed, of whom 51 (21.7 %) developed intracranial hemorrhage. Baseline ONSD values were not significantly different between patients with and without hemorrhage (p = 0.178). Similarly, 24-hour ONSD values did not differ significantly between groups (p = 0.658). In the overall population, 24-hour ONSD was significantly higher than baseline (p < 0.001), regardless of hemorrhage status. Delta ONSD was significantly greater in the hemorrhage group compared to the non-hemorrhage group (0.30 vs. 0.20, p = 0.036). ROC analysis showed no significant predictive ability for baseline ONSD (AUC 0.428, p = 0.117), whereas it showed poor predictive ability for delta ONSD (AUC 0.596, p = 0.036). Baseline ONSD measurement did not predict post-thrombolytic intracranial hemorrhage in acute ischemic stroke patients. Although delta ONSD was higher in patients with hemorrhage, overall changes in ONSD were not sufficient to serve as a reliable standalone predictor.