Correlation Of Optic Nerve Sheath Diameter With Intracranial Pressure And Prognosis In Patients With Cerebral Venous Thrombosis

Background and objective:cerebral venous thrombosis(CVT)is a rare subtype of stroke.Some patients will have persistent neurological impairment.Early prediction or identification of severe CVT is significant to improve the prognosis of patients.Previous studies have identified the correlation between optic nerve sheath diameter(ONSD)and intracranial pressure.And in patients with acute arterial cerebral infarction and intracranial hemorrhage,optic nerve sheath diameter has been proved to have the capacity to identify severe patients and predict poor outcome.However,the ONSD has not been investigated in patients with CVT.In this study,we aimed to measure ONSD and eyeball transverse diameter(ETD)in patients with CVT,and investigate the correlation between ONSD,ONSD/ETD and intracranial pressure,severity and poor prognosis.Methods:The CVT patients from the CVT cohort of Peking Union Medical College Hospital and who meet the enrollment criteria were enrolled.Healthy subjects were included as the control group.The clinical data of the enrolled CVT patients were collected:demographic information,clinical characteristics,imaging data,baseline intracranial pressure(ICP).The baseline ICP was measured by lumbar puncture after admission and before treatment,and intracranial hypertension was defined as ICP?200mmH2O.ONSD evaluation was performed in patients who received 3T brain magnetic resonance within 72 hours after admission and before treatment.The ONSD at the retroocular 3mm(ONSD-3mm),5mm(ONSD-5mm)and ETD were measured on T2 sequence.The severity was evaluated with the modified Rankin Scale(mRS),mRS<2 at admission was regarded as good condition and mRS?2 as poor condition.CVT related complications,including intracranial hemorrhage,disturbance of consciousness and seizures were also used to evaluate the severity of CVT;The outcome was also evaluated by mRS,mRS<2 as good prognosis,while mRS?2 as poor prognosis.The ONSD and ONSD/ETD were compared between CVT patients and healthy controls,intracranial hypertension group and normal ICP group,groups with different severity(including subgroups with good and poor conditions,subgroups with or without intracerebral hemorrhage,subgroups with or without consciousness disturbance,and subgroups with or without seizures),and different outcome.Spearman correlation coefficients was used to analyze the correlation between ONSD and ICP.Logistic regression model was used to accessed the predictive value of ONSD to predict the outcome of CVT.Results:In this study,171 patients in the CVT cohort from 2012 to 2020 were screened,and a total of 62 CVT patients were included,including 38 females and 24 males,with an average age of 36.42 ±15.32 years.A total of 30 healthy controls were included,including 12 males and 18 females.The average age was 38.40 ±8.36.Comparing the ONSD indexes between the CVT group and the healthy controls,it was found that the ONSD and ONSD/ETD were significantly higher in the CVT patients.A total of 43 CVT completed baseline lumbar puncture,of which 27(62.8%)were complicated with intracranial hypertension.The ONSD of CVT patients with intracranial hypertension was significantly higher than that of healthy controls.However,there was no significant difference between CVT patients without intracranial hypertension and healthy controls.And ONSD-3mm(r=0.408,P=0.007),ONSD-3mm/ETD(r=0.476,P=0.035)and ONSD-5mm/ETD(r=0.322,P=0.035)was positively associated with ICP.In the prediction of ICP by ONSD-3mm and ONSD-3mm/ETD,the area under the receiver operating characteristic curve(AUC)were 0.773(95%CI:0.630-0.916)and 0.749(95%CI:0.602-0.896),and the optimal cut-off values were 0.2579 and 5.720,respectively.Among which,patients with high level of ONSD-3mm and ONSD-3mm/ETD were also noticed with poor condition,intracranial hemorrhage,and disturbance of consciousness.However,there was no significant difference between the patients with and without seizures.In the prediction of severity by ONSD-3mm and ONSD-3mm/ETD,the AUC were 0.722(95%CI:0.594-0.849)and 0.691(95%CI:0.540-0.842),and the optimal cut-off values were 0.2650 and 5.835,respectively.However,ONSD-3mm and ONSD-3mm/ETD have no significant correlation with short-term outcome and long-term outcome,and they are not independent predictors of short-term prognosis.Conclusion:This study confirmed that ONSD and ONSD/ETD were significantly correlated with ICP in patients with CVT,which can be used as a reference index for the intracranial hypertension,providing a new non-invasive detection method for the evaluation of ICP in CVT patients.In addition,ONSD-3mm and ONSD/ETD-3mm were related to the severity of CVT patients and had the capacity to identify severe CVT patients at admission.However,this study did not find the correlation between ONSD and the outcome of patients with CVT.