Optic nerve sheath diameter (ONSD) correlation with acute-phase hematoma volume and hematoma expansion in ICH

Background: In numerous intracranial diseases, monitoring intracranial pressure (ICP) is essential for evaluating treatment responses and determining prognosis. While direct ICP measurement is considered reliable, transcranial color-coded sonography (TCCS) offers a non-invasive, bedside approach that provides reliable, real-time data for assessing treatment effectiveness. This study aimed to analyze alterations in the Optic nerve sheath diameter (ONSD) in the acute phase of intracerebral hemorrhage (ICH) using ocular transcranial color-coded sonography (OTCCS) and investigate the correlation between ONSD measurement and hematoma size and expansion. Material and method: This hospital-based case-control study involved 30 patients with spontaneous intracerebral hemorrhage (ICH) and 30 healthy volunteers. We investigated the role of optic nerve sheath diameter (ONSD) assessment via transcranial color-coded sonography (TCCS), conducted 3 mm posterior to the globe, on the early identification of cerebral hypertension (RICP) in ICH patients (excluding those with trauma or cerebral sinus thrombosis) to facilitate timely therapeutic interventions. The collected data were subsequently analyzed using SPSS version 27. Results: The ONSD in the ICH patient group was markedly higher than that observed in healthy volunteers, measuring 5.06±0.55 mm compared to 4.57±0.50 mm, with a statistically significant difference (p<0.001). Furthermore, a correlation was identified between ONSD and age in the ICH and healthy volunteer groups, with correlation coefficients of r=0.57 vs. r=0.82, respectively (p<0.001). However, no significant differences in ONSD were noted based on gender, past medical history, or the location of the hematoma. A receiver operating characteristic (ROC) curve analysis with an area under the curve (AUC) of 0.75 (P<0.01, CI: 95% 0.63-0.87) established an ONSD threshold of 4.62 mm for detecting the rise in intracranial pressure (RICP), demonstrating a favorable balance of sensitivity and specificity at 80% and 53.3%, respectively. Additionally, ONSD was positively correlated with hematoma volume (r=0.626, p<0.001). Changes in ONSD from the baseline to the third day were associated with alterations in the National Institutes of Health Stroke Scale (NIHSS) (r= 0.637, p <0.001), Glasgow Coma Scale (GCS) (r= -0.458, p= 0.011), FOUR Score (r= -0.618, p <0.001), and variations in serum sodium levels (r= -0.456, p <0.001), indicating its potential as a prognostic factor in ICH. Conclusion: The ONSD enlargement assessed using TCCS suggested raised ICP and a poor progression of ICH. ONSD measurement was an independent indicator of hematoma expansion, ICH severity, and prognosis. Therefore, timely intervention should be taken to reduce ICP.