Value of Optic Nerve Sheath Diameter in Diagnosis and Follow Up of Patients with Disturbed Conscious Level

Figures & data

Table 1 The Fundus Examinations

	On Admission		After 48 Hours
	N	%	N	%
Fundus (RT)
Normal	54	71.2%	54	71.2%
Grade I	11	15.1%	11	15.1%
Grade II	7	9.6%	7	9.6%
Grade III	3	4.1%	3	4.1%
Grade IV	1	1.4%	1	1.4%
Fundus (LT)
Normal	55	72.2%	55	72.2%
Grade I	12	16.2%	11	14.9%
Grade I	6	8.1%	7	9.5%
Grade III	2	2.7%	2	2.7%
Grade IV	1	1.4%	1	1.4%
Papilledema
No	55	72.3%	55	72.3%
Yes	21	27.7%	21	27.7%

Figure 1 The ONSD of the right eye on admission (before surgical intervention) (5.89 mm).

Figure 2 The follow-up of ONSD after 48hs of surgical interventions of the previous patient is shown in Figure 1 (4.86 mm).

Figure 3 The correlation between Glasgow coma scale and ONSD on admission. Scattered dot diagram (Blue circles refer to cases).

Figure 4 The correlation between Glasgow coma scale and ONSD after 48hs. Scattered dot diagram (Blue circles refer to cases).

Table 2 The Relation Between ONSD and CT on Admission

	CT Brain				P-value
	Elevated ICP		Non-Elevated ICP
	Mean	SD	Mean	SD
ONSD _RT	6.42	0.64	6.05	0.42	0.004
ONSD _LT	6.47	0.7	6.07	0.39	0.003
Average ONSD	6.45	0.59	6.06	0.38	0.001

Table 3 The Relation Between ONSD and CT Findings After 48 Hours

	CT Brain				P-value
	Elevated ICP		Non-Elevated ICP
	Mean	SD	Mean	SD
ONSD _RT	6.13	0.61	5.47	0.29	<0.0001
ONSD _LT	6.15	0.67	5.39	0.44	<0.0001
Average ONSD	6.14	0.59	5.43	0.32	<0.0001

Table 4 The Fundoscopic Examination in Correlation to ONSD

Fundoscopy	ONSD
	On Admission		After 48 Hours
	Mean	SD	Mean	SD
RT eye
Normal	6.13	0.54	5.68	0.53
Grade I	6.48	0.56	5.90	0.53
Grade II	6.91	0.26	6.49	0.66
Grade III	6.93	0.25	6.52	0.76
Grade IV	6.98	0.03	6.57	0.02
P-value	0.001		0.002
LT eye
Normal	6.16	0.6	5.66	0.68
Grade I	6.52	0.57	5.82	0.50
Grade II	6.85	0.22	6.49	0.69
Grade III	6.92	0.04	6.53	0.31
Grade IV	6.98	0.06	6.60	0.04
P-value	0.033		0.019
Papilledema
Yes	6.52	0.52	6.09	0.58
NO	6.14	0.51	5.67	0.56
P –value	0.006		0.006

Table 5 The Validity of ONSD

	AUC	P-value	Cut-off Point	Sensitivity %	Specificity %
Cases vs controls
ONSD (RT)	0.989	<0.0001	5.36	98.7	100.0
ONSD (RT)	0.990	<0.0001	5.47	98.7	100.0
Average ONSD	0.996	<0.0001	5.38	97.4	100.0
Cases vs cases with CT finding of ICP
ONSD (RT)	0.716	0.001	5.92	76	59
ONSD (RT)	0.709	0.002	5.95	74	56
Average ONSD	0.723	0.001	5.90	82	51

Figure 5 ROC curve for the validity of ONSD (cases vs controls).

Figure 6 ROC curve for the validity of ONSD patients with the evidence of the radiological finding of increased ICP.

Table 6 The Mortality Rate in Correlation to ONSD

	Died in Hospital		Died out of the Hospital		Improved		p-value
	Mean	SD	Mean	SD	Mean	SD
RT ONSD at time of admission	6.4	0.5	6.2	0.7	6.2	0.5	0.167
LT ONSD at time of admission	6.4	0.6	6.3	0.5	6.2	0.7	0.404
Average ONSD at time of admission	6.4	0.5	6.2	0.5	6.2	0.5	0.211
RT ONSD after 48 h	6	0.5	5.9	0.6	5.7	0.6	0.345
LT ONSD after 48 h	5.8	0.6	5.9	0.7	5.7	0.7	0.797
Average ONSD after 48 h	5.9	0.5	5.9	0.6	5.7	0.6	0.574