超声测量视神经鞘直径作为加纳急性中风患者中风严重程度和预后的预测因子

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-05-13 DOI:10.1016/j.jocn.2025.111322

Priscilla Abrafi Opare-Addo , Minas Aikins , Kenneth Ampoful , Sefakor Adinyira , Alfred Kobi , Webster Donaldy , Kwadwo Faka Gyan , Collins Kokuro , Fred Stephen Sarfo

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引用次数: 0

摘要

背景：颅内压（ICP）升高是卒中不良结局的一个真实且可能改变的预测因子。超声测量视神经鞘直径（ONSD）是一种非侵入性的ICP代用指标，可作为急性脑卒中患者严重程度和预后的客观衡量指标。目的评价急性脑卒中患者入院时ONSD、脑卒中严重程度和功能结局之间的关系。方法对加纳某三级医院经神经影像学证实的急性脑卒中患者进行前瞻性队列研究。入院后24 h内测量每位患者的ONSD。采用多变量线性回归确定入院onsd、格拉斯哥昏迷评分（GCS）和30,60和90天修正Rankin评分（mRS）之间的关系。结果116例患者入组，其中缺血性卒中69例，平均（SD）年龄62.6岁±12.8岁，出血性卒中47例，年龄50.9岁±12.2岁（p = 0.000）。颅内压升高的神经影像学特征与入院ONSD升高相关（β 1.253 (95% CI: 0.229-2.277), p = 0.017）。较高的入院ONSD是缺血性卒中患者格拉斯哥昏迷评分较低的独立预测因子（校正β - 8.602 (95% CI - 16.077- 1.127), p = 0.025），但不是出血性卒中患者。对于出血症卒中患者，较高的入院ONSD是第1个月mRS （β 5.363 (95% CI 0.804-9.922), p = 0.022）和第2个月mRS （β 10.546 (95% CI 0.595-20.498), p = 0.039）的独立预测因子。然而，对于缺血性卒中，入院ONSD升高是第2个月（β 16.501 (95% CI 5.202-27.800), p = 0.005）和第3个月（β 16.643 (95% CI 3.666-29.620), p = 0.014） mRS的独立预测因子。结论超声确定的ONSD是加纳队列中风严重程度和功能结局的独立预测因子。随机对照试验探索ONSD在急性脑卒中管理中指导临床决策的潜在作用是有必要的，特别是在资源有限的情况下。

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Sonographically measured optic nerve sheath diameter as a predictor of stroke severity and outcome among Ghanaian acute stroke patients

Background

Elevated intracranial pressure (ICP) is a veritable and potentially modifiable predictor of adverse stroke outcome. Sonographically measured optic nerve sheath diameter (ONSD), a non-invasive proxy for ICP, could potentially be utilized as an objective measure of severity and outcome among acute stroke patients.

Objective

To evaluate the relationship between admission ONSD, stroke severity, and functional outcomes among patients with acute stroke.

Methods

A prospective cohort study was conducted among patients with neuroimaging-confirmed acute strokes admitted to a tertiary hospital in Ghana. The ONSD of each patient was measured within 24 h of admission. Multivariable linear regression was conducted to determine the relationship between admission ONSDs, Glasgow Coma score (GCS), and modified Rankin Score (mRS) at days 30, 60, and 90.

Results

We enrolled 116 patients comprising 69 ischaemic strokes, mean (SD) age 62.6 years ± 12.8 versus 47 hemorrhagic strokes, aged 50.9 years ± 12.2 years (p = 0.000). Presence of neuroimaging features of raised ICP was associated with elevated admission ONSD (β 1.253 (95 % CI: 0.229–2.277), p = 0.017). A higher admission ONSD was an independent predictor of lower Glasgow Coma score in individuals with ischemic strokes (adjusted β −8.602 (95 % CI −16.077- −1.127), p = 0.025) but not hemorrhagic strokes. For individuals with hemorrhagic strokes, higher admission ONSD was an independent predictor of month 1 mRS (β 5.363 (95 % CI 0.804–9.922), p = 0.022) and month 2 mRS (β 10.546 (95 % CI 0.595–20.498), p = 0.039). However, for ischemic strokes, elevated admission ONSD was an independent predictor of mRS at month 2 (β 16.501 (95 % CI 5.202–27.800), p = 0.005) and month 3(β 16.643 (95 % CI 3.666–29.620), p = 0.014).

Conclusion

Sonographically determined ONSD is an independent predictor of stroke severity and functional outcomes in this Ghanaian cohort. Randomized control trials exploring the potential role of ONSD in guiding clinical decisions during acute stroke management are warranted, especially in resource-limited settings.

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.