Dilated optic nerve sheath by ultrasound predicts mortality among patients with acute intracerebral hemorrhage

dc.contributor.authorAntunes, Francisco
dc.contributor.authorZanon, Maria
dc.contributor.authorFernandes, Frederico
dc.contributor.authorMartins Filho, Kleber do Vale
dc.contributor.authorMonteiro, Clara
dc.contributor.authorCosta, Otavio
dc.contributor.authorMunoz Venturelli, Paula
dc.contributor.authorBoulouis, Gregoire
dc.contributor.authorNorkin, Joshua
dc.contributor.authorMarques, Octavio
dc.description.abstractBackground: Intracerebral hemorrhage (ICH) is a deadly disease and increased intracranial pressure (ICP) is associated with worse outcomes in this context. Objective: We evaluated whether dilated optic nerve sheath diameter (ONSD) depicted by optic nerve ultrasound (ONUS) at hospital admission has prognostic value as a predictor of mortality at 90 days. Methods: Prospective multicenter study of acute supratentorial primary ICH patients consecutively recruited from two tertiary stroke centers. Optic nerve ultrasound and cranial computed tomography (CT) scans were performed at hospital admission and blindly reviewed. The primary outcome was mortality at 90-days. Multivariate logistic regression, ROC curve, and C-statistics were used to identify independent predictors of mortality. Results: Between July 2014 and July 2016, 57 patients were evaluated. Among those, 13 were excluded and 44 were recruited into the trial. Their mean age was 62.3 ± 13.1 years and 12 (27.3%) were female. On univariate analysis, ICH volume on cranial CT scan, ICH ipsilateral ONSD, Glasgow coma scale, National Institute of Health Stroke Scale (NIHSS) and glucose on admission, and also diabetes mellitus and current nonsmoking were predictors of mortality. After multivariate analysis, ipsilateral ONSD (odds ratio [OR]: 6.24; 95% confidence interval [CI]: 1.18-33.01; p = 0.03) was an independent predictor of mortality, even after adjustment for other relevant prognostic factors. The best ipsilateral ONSD cutoff was 5.6mm (sensitivity 72% and specificity 83%) with an AUC of 0.71 (p = 0.02) for predicting mortality at 90 days. Conclusion: Optic nerve ultrasound is a noninvasive, bedside, low-cost technique that can be used to identify increased ICP in acute supratentorial primary ICH patients. Among these patients, dilated ONSD is an independent predictor of mortality at 90 days. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (
dc.identifier.citationDias FA, Zotin MCZ, Alessio-Alves FF, Martins Filho RKDV, Barreira CMA, Vincenzi OC, Venturelli PM, Boulouis G, Goldstein JN, Pontes-Neto OM. Dilated optic nerve sheath by ultrasound predicts mortality among patients with acute intracerebral hemorrhage. Arq Neuropsiquiatr. 2023 Oct;81(10):861-867. doi: 10.1055/s-0043-1775885
dc.subjectTranstornos Cerebrovasculares
dc.subjectAccidente Vascular Cerebral
dc.subjectHipertension Intracraniana
dc.subjectHemorragia Cerebral Intraventricular
dc.subjectNervio Óptico
dc.titleDilated optic nerve sheath by ultrasound predicts mortality among patients with acute intracerebral hemorrhage
dc.title.alternativeA bainha do nervo óptico dilatada na ultrassonografia prediz mortalidade na hemorragia intraparenquimatosa aguda
dcterms.accessRightsAcceso Abierto
dcterms.sourceArquivos de neuro-psiquiatria


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