What question did this study set out to answer?

The aim is to assess optic nerve sheath diameter (ONSD) as a prognostic marker for intracranial pressure and outcomes in stroke patients.

July 5, 2026Open Access

Admission optic nerve sheath diameter and optic nerve sheath diameter/eyeball transverse diameter ratio as prognostic markers in stroke

Key Points

The aim is to assess optic nerve sheath diameter (ONSD) as a prognostic marker for intracranial pressure and outcomes in stroke patients.
Retrospective analysis of 36 adult stroke patients from a tertiary care ICU between March and September 2022.
Bilateral ONSD and eyeball transverse diameter (ETD) measurements were taken from neuroimaging; multiple imputation and multivariable regression were used for analysis.
Outcomes assessed included ICU mortality, need for decompressive surgery, ventilator days, and ICU stay.
ICU mortality was observed in 11.1% of patients, with 33.3% undergoing decompressive surgery.
ONSD_max was 7.12 ± 1.10 mm, with higher values in patients who died in the ICU (median 7.6 mm) compared to survivors (7.0 mm).
ONSD_max demonstrated better mortality discrimination (AUC 0.70) compared to mean ONSD (AUC 0.48), while mean ONSD significantly predicted ventilator duration (b = 0.44 ± 0.18, p = 0.015).

Abstract

Objectives: Raised intracranial pressure (ICP) is a major determinant of secondary injury in acute stroke. Optic nerve sheath diameter (ONSD), measurable on computed tomography and magnetic resonance imaging, may provide a simple non-invasive surrogate of ICP, but data from Indian stroke populations are limited. Materials and Methods: This retrospective study analyzed 36 adult patients with ischemic or hemorrhagic stroke admitted to a tertiary intensive care unit between March and September 2022. Of 54 eligible patients, 36 had complete imaging suitable for standardized ONSD and eyeball transverse diameter (ETD) measurements and complete outcome data and were included in the final analysis. Bilateral ONSD and ETD were measured from admission neuroimaging, and mean ONSD, maximum ONSD (ONSDₘax), ONSD asymmetry, and ONSD/ETD ratio were calculated. Outcomes included intensive care unit (ICU) mortality, decompressive surgery, ventilator days, and ICU stay. Multiple imputation and multivariable regression were used. Results: The mean age was 55. 5 ± 17. 4 years; 72% were male. Hypertension (58%) and diabetes (44%) were common. Ischemic stroke predominated (72%). Midline shift and herniation were present in 42% and 11%, respectively. ICU mortality occurred in 4 patients (11. 1%), and 12 patients (33. 3%) underwent decompressive hemicraniectomy. Mean ONSD was 6. 59 ± 0. 99 mm, ONSDₘax 7. 12 ± 1. 10 mm, and ONSD/ETD ratio 0. 290 ± 0. 060. Patients who died in the ICU had higher ONSDₘax values compared with survivors (median 7. 6 mm vs. 7. 0 mm). ONSDₘax demonstrated better mortality discrimination (area under the curve AUC 0. 70) than mean ONSD (AUC 0. 48). Mean ONSD significantly predicted ventilator duration (b = 0. 44 ± 0. 18, p = 0. 015). ONSD asymmetry and ONSD/ETD ratio showed no independent prognostic value. Conclusion: In this Indian ICU stroke cohort, ONSDₘax demonstrated better mortality discrimination than mean ONSD, while mean ONSD predicted duration of mechanical ventilation. These findings highlight ONSDₘax as a simple, clinically relevant biomarker of raised ICP, particularly valuable in resource-limited settings.

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