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Original article
Distal enlargement of the optic nerve sheath in the hyperacute stage of intracerebral haemorrhage
  1. David Školoudík1,2,
  2. Roman Herzig2,
  3. Táňa Fadrná1,
  4. Michal Bar1,
  5. Pavel Hradílek1,
  6. Martin Roubec1,
  7. Monika Jelínková1,
  8. Daniel Šaňák2,
  9. Michal Král2,
  10. Jana Chmelová3,
  11. Miroslav Heřman4,
  12. Kateřina Langová5,
  13. Petr Kaňovský2
  1. 1Department of Neurology, University of Ostrava, Ostrava, Czech Republic
  2. 2Department of Neurology, Palacký University and University Hospital, Olomouc, Czech Republic
  3. 3Department of Radiology, University Hospital and University of Ostrava, Ostrava, Czech Republic
  4. 4Department of Radiology, Faculty of Medicine and Dentistry, Palacký University and University Hospital, Olomouc, Czech Republic
  5. 5Institute of Medicine Biophysics, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic
  1. Correspondence to Professor David Školoudík, Department of Neurology, University Hospital Ostrava, Tr. 17. listopadu 1790, Ostrava CZ-708 52, Czech Republic; skoloudik{at}


Aims Optic nerve sheath diameter (ONSD) enlargement is detectable in patients with increased intracranial pressure. The aim was to detect an enlargement of the ONSD using optic nerve sonography in patients with acute intracerebral haemorrhage (ICH) within 6 h of the onset of symptoms.

Methods Thirty-one acute ICH patients, 15 age-matched acute ischaemic stroke patients and 16 age-matched healthy volunteers were enrolled consecutively in this prospective bi-centre observational study. All acute stroke patients underwent brain CT, optic nerve sonography and transcranial colour-coded duplex sonography (TCCS) at admission within 6 h of stroke onset. The ONSD both 3.0 and 12.0 mm behind the globe using optic nerve sonography were recorded and statistically evaluated, as were age, sex, haemorrhage volume and midline shift measured by CT, and blood flow velocities in both middle cerebral arteries using TCCS.

Results In acute ICH patients, a significant enlargement of ONSD was detected (p<0.0083). The best cut-off point to predict ICH volume >2.5 cm3 was the relative ONSD enlargement of >0.66 mm (>21 %), with 90.3% accuracy and kappa coefficient 0.760 (95% CI 0.509 to 1.000).

Conclusions Sonographically measured enlargement of the ONSD may already be detectable in the hyperacute stage of increased intracranial pressure.

  • Intracerebral haemorrhage
  • intracranial pressure
  • optic nerve
  • ultrasound
  • pathology
  • imaging

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  • Funding The study was partially supported by the grant projects of the Ministry of Education, Czech Republic, number MSM6198959216. There are no conflicts of interest associated with this manuscript, financial or otherwise.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the local ethics committees of the University Hospital Ostrava and the University Hospital Olomouc, and was conducted in accordance with the Helsinki Declaration of 1975 (as revised in 1983 and 2008).

  • Provenance and peer review Not commissioned; externally peer reviewed.