Role of Optic Nerve Sheath Diameter in Patients with Malignant Cerebral Infarction: A Case Series

Malignant Middle Cerebral Artery (MCA) infarction leads to severe cerebral oedema and raised Intracranial Pressure (ICP). Bedside ultrasonographic measurement of Optic Nerve Sheath Diameter (ONSD) is a noninvasive surrogate for ICP. Ten consecutive patients with malignant MCA infarction were included. ONSD was measured bilaterally at admission, 24 hours, day 3, day 5, and day 7. CT-based midline shift and modified Rankin Scale at discharge were recorded. All 10 patients presented with low Glasgow Coma Scale (GCS). Larger ONSD and greater midline shift were associated with poorer outcomes. Serial ONSD measurements reflected trends in cerebral oedema progression, supporting ONSD ultrasonography as a useful non-invasive bedside tool for monitoring ICP in malignant MCA infarction, although larger studies are required for validation.