Open Access Research Article

Variability Index of Optic Nerve Diameter with Hyperosmolar Therapy in Patients with Acute Neurological Injury

Lleny Bocanegra Flores1* , Felipe de Jesús Montelongo2 , María Magdalena Reyes Pérez1 and Blanca Estela Herrera Morales3

1Attending physician in the Neurointensive and Intensive Care Unit, Hospital General de Ecatepec Las Américas ISEM, Mexico

2Chief of the Neurointensive and Intensive Care Unit, Hospital General de Ecatepec Las Américas ISEM, Mexico

3Health Education and Research Coordinator at HGR 196 IMSS, Mexico

Corresponding Author

Received Date: October 07, 2021;  Published Date: October 28, 2021


Introduction: Intracranial hypertension (IH) is a serious complication derived from increased pressure of brain content. It has been shown that dilation of the optic nerve sheath is a manifestation prior to the elevation of intracranial pressure (ICP) since it is a central nervous system continuum. Acute neurological injury (ANI) is a serious disease with a high risk of mortality and sequelae with non-specific clinical signs. ICP monitoring requires invasive instrumentation; however, now there is non-invasive monitoring by transorbital ocular ultrasonography, which measures the optic nerve sheath diameter (ONSD). Therefore, we propose a new variability index of the optic nerve sheath diameter (VIONSD) that allows determining the response to hyperosmolar therapy treatment as it is an alternative neuromonitoring method.

Objective: To determine the VIONSD for the treatment with hyperosmolar therapy in patients with ANI in the Neurointensive Care Service of the Hospital General de Ecatepec “Las Américas” in the State of Mexico, Mexico, by carrying out a prospective longitudinal observational analytical study.

Results: The trial included 29 patients with a median age of 42 years with a range of 30 to 58 years. A significant difference was obtained between the Glasgow score and the variability of the optic nerve diameter of < 0.05 in pre- and post-treatment. A ROC curve for the VIONSD was made by finding a cut-off point between the responder (6 %) and a cut-off point for the VIONSD with the score of the Glasgow coma scale (4.72 %).

Conclusions: The VIONSD measurement was determined as a tool for monitoring patients with ANI, which is a dynamic process in the changes of intracerebral pressure that has a change in the ONSD in a 30-minutes average time.

Keywords:Optic nerve sheath diameter; Intracranial hypertension; Neurological injury; Variability index of the optic nerve sheath diameter; Optic transcranial ultrasound

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