This website is intended for Medical Professionals only. By using this site you confirm that you are a healthcare professional.

News
Recurrent miscarriage: diabetes drug could ... An existing drug can be used to improve the womb for pregnancy, ... (08 Jan 2020)
Nerve Stimulation May Benefit Women with ... A treatment involving electrical nerve stimulation helped women ... (08 Jan 2020)
Cancer drugs could potentially treat COPD, ... New research from the University of Sheffield shows a certain ... (08 Jan 2020)
Tea drinkers live longer Drinking tea at least three times a week is linked with a longer ... (08 Jan 2020)

Optic nerve may help predict stroke patient death risk

The diameter of the sheath that encases the optic nerve may help indicate which stroke patients are at highest risk of dying within six months. For every added millimeter of optic nerve sheath diameter, risk of death was four to six times higher.
Using optic ultrasound to measure the sheath of a nerve that connects the eye and brain can help identify acute stroke patients most at risk of dying within days or months, according to research presented at the American Stroke Association’s International Stroke Conference 2015.
The new study aimed to quickly and noninvasively identify stroke patients who are at risk from increased pressure inside the skull – which is thought to reflect stroke severity and is the major cause of death. Measuring the thickness of the optic nerve sheath may be a simple test for increased intracranial pressure, said Vishnumurthy S. Hedna, M.D., lead researcher and assistant professor of neurology at the University of Florida College of Medicine in Gainesville, Fla.
“Ultrasound on the optic nerve can be used to test your brain for swelling, which sometimes occurs after a major stroke,” Hedna said. “This can be done by looking at the nerve diameter behind your eye with ultrasound images, since it is thought that when your brain swells, pressure gets transmitted towards your eyes,” Hedna said. “This would help doctors treat your stroke with medications that would reduce brain pressures.”
The study involved 86 patients at the University of Florida’s Shands Hospital in Gainesville, Fla., who were suspected of having a buildup of pressure in the skull after their stroke. Researchers used ocular ultrasound to measure the sheath that encases the optic nerve.
For patients who later died of a stroke due to a blood vessel blockage, average diameter of the nerve sheath was 5.82 millimeters, versus 5.33 millimeters in those who survived. In patients with a bleeding stroke, average diameter was 6.23 millimeters for those who died, versus 5.72 for survivors.
For every millimeter bigger the nerve sheath diameter was, the risk of death within six months was four times as high in patients whose stroke was due to a blood vessel blockage, and six times as high in patients who had a bleeding stroke. Most of the deaths occurred within a month of patients’ hospitalization. The study also suggested that the larger the nerve sheath measurement, the more disabled a patient was likely to be six months later.
Optic ultrasound is a safe, routine bedside test that is performed using gel and a device placed on closed eyelids, Hedna said. “Optic ultrasound is easy to do, and has been described in many studies as easily teachable. Other methods are invasive, involve radiation, and are not cost-effective.”
Currently, intracranial pressure is monitored directly from within the skull or with a spinal tap. In the future, the findings could help doctors assign risk levels to patients during their initial exam without performing invasive testing, and when needed, act earlier to monitor intracranial pressure, give medicine to diminish it, place a drain in the head to reduce fluid buildup, or otherwise change management of the patient, Hedna said.
The researchers measured two dimensions of the nerve sheath in each eye on both the first and second day a patient was hospitalized after a stroke, totaling eight measurements for most patients. The study based its estimates of death risk mainly on measurements taken on day two, but for patients who soon died or were quickly discharged from intensive care, only one day’s measurements were available. The researchers are still studying whether differences in optic nerve sheath diameter from day one to day two were related to patients’ risk of death or disability.
The team plans to study whether treating patients for fluid buildup on the brain based on an abnormal neurological exam plus a bigger nerve sheath affects how they fare, compared with patients who have usual care. The most severely impaired patients “are probably the ones who would get medications to decrease brain edema later in the course of their illness anyway,” Hedna said. “We feel the optic nerve sheath diameter would just help the clinician make the decision sooner.”
The ultrasound test is likely to be useful in stroke care only when given soon after stroke injury, he said. “Brain swelling after stroke usually peaks between three to four days, hence its use in the acute stroke setting.”


Source: American Heart Association

Full bibliographic information:
Optic nerve may help predict stroke patient death risk
Vishnumurthy S. Hedna, M.D.
Use of Optic Nerve Sheath Diameter in Emergency Department to Predict Stroke Outcome


Highlights

  • Nescafé 3 in1 LifeCycle HEROES return from South Asia

    Donations for Nescafé 3in1 LifeCycle Challenge 2019 can be sent via sms: 5061 7370 = €2.33; 5061 8920 = €6.99; 5061 9229 = €11.65; or via a call to 5160 2020 = €10, 5170 2005 = €15; and 5180 2006 = €25. Bank details are Swift code VALLMTMT, IBAN number MT 18 VALL 22013000000014814521017, Bank name Bank of Valletta, Account number 14814521017.

    Read more...
  • Give a Gift this Christmas which gives back

    The story of medicine is the story of civilization, from an ancient craft of primitive magic and religion to the sophisticated field of science and technology of today.

    Read more...

Join

Connect with other Medical Professionals on fb in a closed facebook group

Login

Top
We use cookies to improve our website. By continuing to use this website, you are giving consent to cookies being used. More details…