Ultrasonographic Evaluation of Optic Nerve Sheath Diameter Change Before and After Thrombolytic Treatment in Acute...

Thrombolytic therapy is the mainstay therapy for acute ischemic stroke (AIS) in the modern era. Intracranial hemorrhage (ICH) is one of the most common thrombolytic therapy complications and can cause significant problems. Non-invasive methods, such as ultrasonography (USG), are becoming prominent to detect ICH early.

We aimed to measure the USG optic nerve sheath diameter (ONSD) in patients with AIS before and after thrombolytic therapy and to find out whether there is any correlation with the complications at 24 hours.

Patients aged 18 years and over who were deemed suitable for thrombolytic treatment in AIS patients who presented to the emergency department of two tertiary training and research hospitals were included in the study, which was planned to be two-center, prospective observational, and cross-sectional study between March 25, 2022, and October 25, 2022. Before and after the thrombolytic treatment (0.hour, 1.hour, and 4.hour), ONSD was measured by an emergency physician at the bedside with an USG device. Patients with and without complications after thrombolytic therapy were grouped, and the ONSD measurements were compared.

The most common complications in 116 patients included in the study were ICH in 10.3% (n = 12), brain edema in 8.6% (n = 10), and shift in 0.9% (n = 1). We found statistically significant high values in the 4th-hour ONSD measurements in the group with complications (right, P = 0.004, left, P = 0.053). We found statistically significantly higher ONSD values in the group with complications in the 24th-hour measurements with computed tomography (CT) compared to the group without complications (P < 0.001).

We think that the follow-up of ONSD values with USG is a useful parameter in predicting the complications that may develop after thrombolytic therapy and in monitoring intracranial pressure (ICP).