The Correlation Between The Diameter Of Optic Nerve Sheath Measured By Ultrasound And The Increase Of Intracranial Pressure In Patients With Brain Infection And The Changes After Treatment

Objective:To investigate the correlation between ultrasound examination of optic nerve sheath diameter(ONSD)and lumbar puncture measurement of intracranial pressure(ICP)in patients with brain infection,and to evaluate the dynamic changes of ONSD and ICP in individuals before and after ICP treatment.Methods:(1)From July 2022 to February 2023,patients who needed lumbar puncture examination due to brain infection in the Fourth Affiliated Hospital of Nanchang University and the Department of Neurology of the First Affiliated Hospital of Nanchang University were collected.According to the inclusion and exclusion criteria,the ONSD value before lumbar puncture was measured and recorded using a color Doppler ultrasound instrument.The lumbar puncture was performed,and the lumbar puncture cerebrospinal fluid pressure was recorded as ICP.The lumbar puncture cerebrospinal fluid pressure ≥ 200 mm H20 was defined as an increase in ICP,The age,gender,body mass index(BMI),systolic blood pressure,diastolic blood pressure,and mean arterial pressure of the patients were recorded.The enrolled patients were divided into ICP normal group and ICP elevated group.The age,gender,BMI,systolic blood pressure,and diastolic blood pressure of the patients in the ICP normal group and ICP elevated group were compared The correlation between mean arterial pressure and ONSD was analyzed statistically.The correlation between the clinical data of the normal ICP group,the elevated ICP group,and the average ONSD in both eyes of all study subjects was analyzed.The difference between ONSD in the left and right eyes of the same subject was analyzed.The ROC curve was used to determine the optimal threshold value for ONSD to determine ICP elevation.(2)Measure and record ONSD using color Doppler ultrasound before lumbar puncture surgery;Review lumbar puncture surgery,and record the cerebrospinal fluid pressure of lumbar puncture as ICP after treatment.Compare the correlation between ONSD and ICP before and after intracranial pressure reduction treatment in the same patient.Result:(1)The lumbar puncture cerebrospinal fluid pressure of 80 to 200 mm H20 was defined as ICP normal.A total of 33 study subjects were collected,including 16 patients in the ICP normal group and 17 patients in the ICP elevated group,The mean binocular ONSD in the ICP normal group was 4.51 ± 0.36 mm,while the mean binocular ONSD in the ICP increased group was 5.61 ± 0.58 mm.The difference between the two groups was statistically significant(t=6.588,P<0.01).The difference between the ICP normal group and the ICP increased group in age,gender,BMI,systolic blood pressure,diastolic blood pressure,and mean arterial pressure was not statistically significant(P>0.05).There was no significant correlation between mean ONSD in both eyes and age,BMI,systolic blood pressure,diastolic blood pressure,and mean arterial pressure(P>0.05).The relationship between mean ONSD in both eyes and ICP was positive(r=0.89,P<0.01),with a strong correlation.The average ONSD of male eyes was greater than that of female eyes(P<0.05).There was no significant difference in ONSD between the left and right eyes of the same study object(t=0.540,P>0.05).The ROC curve was drawn to indicate that the optimal threshold for assessing ICP elevation by ultrasound measurement of the mean ONSD in both eyes was 5.04 mm,with a sensitivity of 88%,and a specificity of 100%.(2)Collect 9 patients who need to undergo lumbar puncture surgery after receiving treatment to reduce ICP,The average value of ONSD after ICP lowering treatment was 0.62 mm lower than the average value of ONSD before treatment,with a 95% confidence interval of-1.1161 to-0.1367.The difference was statistically significant(t=-2.949,P<0.05).For the same patient,the difference in ICP before and after treatment is Δ ICP,the difference between ONSD is Δ ONSD,the relationship between the two is positively correlated(r=0.84,P<0.01),and the degree of correlation is strongly correlated.Conclusion:The average value of ONSD in both eyes measured by ultrasound can judge the increase of ICP in patients with brain infection,and there is a strong correlation.The optimal threshold value for evaluating the increase of ICP by the average value of ONSD in both eyes measured by ultrasound is 5.04 mm.There is no difference between the average ONSD values in the left and right eyes of the same study object.Ultrasonic measurement of ONSD can dynamically observe the changes in ICP levels.