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Background: Imaging plays integral role in the evaluation of patients with acute traumatic brain injury (TBI), with computerized tomography (CT) being the modality of the choice and the most commonly utilized imaging tool. One of the important determinants of TBI severity is raised intracranial pressure (ICP). Optic nerve sheath diameter (ONSD) was considered as a reliable indirect surrogate for the raised ICP, however, studies assessing role of CT-derived ONSD in evaluation of patients with raised ICP or brain injury are limited.

Aim of the study: To assess the correlation between ONSD measured by CT scan and the severity of TBI according to Marshall scale.

Patients and methods: A cross-sectional analytic study was conducted on 60 adult patients (52 males, 8 females) presented with acute TBI and referred for brain CT examination. After initial general evaluation of brain CT images, the score of TBI was assessed according to Marshal's scale (I to VI). The transverse ONSD was manually measured on axial CT image at 3 mm distance behind eye globe. The correlation between the grade of TBI and ONSD was subjected to statistical analysis. The study was approved by the Institutional Ethical Review Committee.

Results: The means of all, right-sided and left-sided ONSD were 4.695 mm, 4.606 mm and 4.785 mm respectively. There was positive, linear and statistically significant correlation (p value <0.001, r = 0.662) between the mean of ONSD measured by CT scan and Marshall score. When the ONSD measurements of the right and left sides were analyzed separately, the correlation was also significant and positive (r= 0.504 for the right side, r = 0.699 for the left side with p value <0.001 for both). ONSD showed weakly negative and statistically not significant correlation (p value= 0.571, r = - 0.075) with the duration between onset of the trauma and time of CT examination. There was no significant difference between mean ONSD measurements when correlated with the laterality of TBI, age or gender (p values 0.392 0.328 and 0.462 respectively).

Conclusion: ONSD measured on brain CT scan is positively correlated with the severity of TBI as assessed by Marshall scale. Because Marshall scale has prognostic implication, ONSD may also have a prognostic value during assessment of patients with TBI.

References

  1. Ghajar J. Traumatic brain injury. Lancet. 2000; 356(9233): 923-9.
     Google Scholar
  2. Ramanana-Rao DV, NVP D, Chandra TJ. Role of Computed Tomography (CT) in traumatic head injury evaluation-a cross-sectional study. Int J Med Res Rev. 2020; 8(1): 40-4
     Google Scholar
  3. Lee B, Newberg A. Neuroimaging in traumatic brain imaging. NeuroRx. 2005; 2(2): 372-83.
     Google Scholar
  4. Glauser J. Head injury: which patients need imaging? Which test is best? Cleve Clin J Med. 2004; 71: 353-357.
     Google Scholar
  5. Marshall LF, Marshall, SB, Klauber MR, Clark Mv B, Eisenberg HM, Jane JA, et al. A new classification of head injury based on computerized tomography. Journal of Neurosurgery. 1991; 75 (Supplement): S14-S20.
     Google Scholar
  6. Сarney N, Totten AM, OʼReilly C, Ullman JS, Hawryluk GW, Bell M, et al. Guidelines for the management of severe traumatic brain injury, 4th ed. Neurosurgery. 2016; 80(1): 6-15.
     Google Scholar
  7. Hightower S, Chin EJ, Heiner JD. Detection of increased intracranial pressure by Ultrasound. Journal of Special Operations. 2012; 12(3): 19-22.
     Google Scholar
  8. Cammarata G, Ristango, G, Cammarata, A, Mannanici G, Denaro C, Gullo A. Ocular ultrasound to detect intracranial hypertension intrauma patients. J Trauma. 2011; 71: 779-81.
     Google Scholar
  9. Pappu, S, Lerma, J, Khraishi T. Brain CT to Assess Intracranial Pressure in Patients with Traumatic Brain Injury. J Neuroimaging. 2016; 26: 37-40.
     Google Scholar
  10. Abdelrahman AS, Barakat MMK. MRI measurement of optic nerve sheath diameter using 3D driven equilibrium sequence as a non-invasive tool for the diagnosis of idiopathic intracranial hypertension. Egypt J Radiol Nucl Med. 2020; 51: 24.
     Google Scholar
  11. Caffery TS, Perret JN, Musso MW, Jones GN. Optic nerve sheath diameter and lumbar puncture opening pressure in nontrauma patients suspected of elevated intracranial pressure. Am J Emerg Med. 2014; S0735-6757.
     Google Scholar
  12. Sekhon MS, Griesdale DE, Robba C, Walland K. Optic nerve sheath diameter on computed tomography is correlated pressure in patients with severe traumatic brain injury. Intensive Care Medicine. 2014; 40(9): p1267.
     Google Scholar
  13. Kimberly HH, Noble VE. Using MRI of the optic nerve sheath to detect elevated intracranial pressure. Crit Care. 2008; 12: 181
     Google Scholar
  14. Legrand A, Jeanjean P, Delanghe F, Peltier J, Lecat B, Dupont H. Estimation of optic nerve sheath diameter on an initial brain computed tomography scan can contribute prognostic information in traumatic brain injury patients. Crit Care. 2013; 17(2): R61
     Google Scholar
  15. Murray NM, Wolman DN, Mlynash M, Threlkeld ZD, Christensen S, Heit JJ et al. Early Head Computed Tomography Abnormalities Associated with Elevated Intracranial Pressure in Severe Traumatic Brain Injury. J Neuroimaging. 2021; 31(1): 199-208.
     Google Scholar
  16. Lietke S, Zausinger S, Patzig M, Holtmanspötter M, Kunz M. CT-Based Classification of Acute Cerebral Edema: Association with Intracranial Pressure and Outcome. J Neuroimaging. 2020; 30(5): 640-647.
     Google Scholar
  17. Kalantari H, Jaiswal R, Bruck I, Matari H, Ghobadi F, Weedon J, et al. Correlation of optic nerve sheath diameter measurements by computed tomography and magnetic resonance imaging. Am J Emerg Med. 2013; 31(11): 1595-7.
     Google Scholar
  18. Al-Tameemi H, Helel NM. Agreement Between Computed Tomography and Magnetic Resonance Imaging In Measuring Optic Nerve Sheath Diameter. Global Journal of Health Science. 2018; 10 (4): 2018
     Google Scholar
  19. Saatman KE, Duhaime AC, Bullock R, Maas AI, Valadka A, Manley GT. Classification of traumatic brain injury for targeted therapies. J. Neurotrauma. 2008; 25 (7): 719-738.
     Google Scholar
  20. Steyerberg EW, Mushkudiani N, Perel P, Butcher I, Lu J, McHugh GS, et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med. 2008; 5(8): e165
     Google Scholar
  21. Liu M, Yang ZK, Yan YF, Shen X, Yao HB, Fei L, et al. Optic Nerve Sheath Measurements by Computed Tomography to Predict Intracranial Pressure and Guide Surgery in Patients with Traumatic Brain Injury. World Neurosurg. 2020; 134: e317-e324.
     Google Scholar
  22. Maas AI, Hukkelhoven CW, Marshall LF, Steyerberg EW. Prediction of outcome in traumatic brain injury with computed tomographic characteristics: a comparison between the computed tomographic classification and combination of computed tomographic predictors. Neurosurgery. 2005; 57(6): 1173-1182.
     Google Scholar
  23. Soldatos T, Karakitsos D, Chatzimichail K, Papathanasiou M, Gouliamos A, Karabinis A. Optic nerve sonography evaluation of adult brain injury. Critical Care. 2008; 12: R67.
     Google Scholar