Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia · 2025
Sonographically measured optic nerve sheath diameter as a predictor of stroke severity and outcome among Ghanaian acute stroke patients.
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Opare-Addo Priscilla Abrafi, Aikins Minas, Ampoful Kenneth, Adinyira Sefakor, Kobi Alfred, Donaldy Webster, Gyan Kwadwo Faka, Kokuro Collins, Sarfo Fred Stephen
Аннотация
BACKGROUND: Elevated intracranial pressure (ICP) is a veritable and potentially modifiable predictor of adverse stroke outcome. Sonographically measured optic nerve sheath diameter (ONSD), a non-invasive proxy for ICP, could potentially be utilized as an objective measure of severity and outcome among acute stroke patients.
OBJECTIVE: To evaluate the relationship between admission ONSD, stroke severity, and functional outcomes among patients with acute stroke.
METHODS: A prospective cohort study was conducted among patients with neuroimaging-confirmed acute strokes admitted to a tertiary hospital in Ghana. The ONSD of each patient was measured within 24 h of admission. Multivariable linear regression was conducted to determine the relationship between admission ONSDs, Glasgow Coma score (GCS), and modified Rankin Score (mRS) at days 30, 60, and 90.
RESULTS: We enrolled 116 patients comprising 69 ischaemic strokes, mean (SD) age 62.6 years ± 12.8 versus 47 hemorrhagic strokes, aged 50.9 years ± 12.2 years (p = 0.000). Presence of neuroimaging features of raised ICP was associated with elevated admission ONSD (β 1.253 (95 % CI: 0.229-2.277), p = 0.017). A higheradmission ONSD was an independent predictor of lowerGlasgow Coma scorein individuals with ischemic strokes (adjusted β -8.602 (95 % CI -16.077- -1.127), p = 0.025) but not hemorrhagic strokes. For individuals with hemorrhagic strokes, higher admission ONSD was an independent predictor of month 1 mRS (β 5.363 (95 % CI 0.804-9.922), p = 0.022) and month 2 mRS (β 10.546 (95 % CI 0.595-20.498), p = 0.039). However, for ischemic strokes, elevatedadmissionONSD was an independent predictor of mRS at month 2 (β 16.501 (95 % CI 5.202-27.800), p = 0.005) and month 3(β 16.643 (95 % CI 3.666-29.620), p = 0.014).
CONCLUSION: Sonographically determined ONSD is an independent predictor of stroke severity and functional outcomes in this Ghanaian cohort. Randomized control trials exploring the potential role of ONSD in guiding clinical decisions during acute stroke management are warranted, especially in resource-limited settings.
OBJECTIVE: To evaluate the relationship between admission ONSD, stroke severity, and functional outcomes among patients with acute stroke.
METHODS: A prospective cohort study was conducted among patients with neuroimaging-confirmed acute strokes admitted to a tertiary hospital in Ghana. The ONSD of each patient was measured within 24 h of admission. Multivariable linear regression was conducted to determine the relationship between admission ONSDs, Glasgow Coma score (GCS), and modified Rankin Score (mRS) at days 30, 60, and 90.
RESULTS: We enrolled 116 patients comprising 69 ischaemic strokes, mean (SD) age 62.6 years ± 12.8 versus 47 hemorrhagic strokes, aged 50.9 years ± 12.2 years (p = 0.000). Presence of neuroimaging features of raised ICP was associated with elevated admission ONSD (β 1.253 (95 % CI: 0.229-2.277), p = 0.017). A higheradmission ONSD was an independent predictor of lowerGlasgow Coma scorein individuals with ischemic strokes (adjusted β -8.602 (95 % CI -16.077- -1.127), p = 0.025) but not hemorrhagic strokes. For individuals with hemorrhagic strokes, higher admission ONSD was an independent predictor of month 1 mRS (β 5.363 (95 % CI 0.804-9.922), p = 0.022) and month 2 mRS (β 10.546 (95 % CI 0.595-20.498), p = 0.039). However, for ischemic strokes, elevatedadmissionONSD was an independent predictor of mRS at month 2 (β 16.501 (95 % CI 5.202-27.800), p = 0.005) and month 3(β 16.643 (95 % CI 3.666-29.620), p = 0.014).
CONCLUSION: Sonographically determined ONSD is an independent predictor of stroke severity and functional outcomes in this Ghanaian cohort. Randomized control trials exploring the potential role of ONSD in guiding clinical decisions during acute stroke management are warranted, especially in resource-limited settings.