El síndrome de Terson diagnosticado por ecografía como indicador de extrema gravedad en pacientes neurocríticos / Ultrasound diagnosis of Terson syndrome as an indicator of extreme severity in neurocritical care patients

Introducción: Se denomina síndrome de Terson (ST) a cualquier tipo de hemorragia intraocular (HIO), identificada en pacientes con patología aguda intracraneal. El ST parece estar relacionado con la gravedad clínica en la hemorragia subaracnoidea (HSA), pero en pacientes con trauma craneoencefálico (TCE) y hemorragia intracerebral (HIC), su asociación está por definir. Diseñamos este estudio para evaluar el rendimiento de la ecografía ocular (EO) y su utilidad en la práctica clínica.Materiales y métodosRealizamos un estudio observacional prospectivo, unicéntrico en pacientes neurocríticos. Analizamos los casos con respecto a los controles, identificados con oftalmoscopia indirecta (OI), y por EO. Determinamos las características diagnósticas de la EO. Hicimos un análisis multivariante para determinar asociaciones clínicamente relevantes.ResultadosSe incluyeron 91 pacientes con diagnósticos de HIC (41,76%), HSA (29,67%) y TCE (28,57%). El ST fue identificado por EO en ocho pacientes (8,79%) y en 24 pacientes (24,37%) por OI. La mortalidad ajustada para los pacientes con ST tuvo una OR 4,15 con IC 95% (1,52 - 11,33). Todos los pacientes con ST identificados por EO presentaron una escala de coma de Glasgow < 9 y tuvieron un riesgo elevado de precisar craniectomía descompresiva, una OR 9,84 (1,64 - 59). La EO alcanzó una sensibilidad global de 30,43%, una especificidad del 98,53%, con una precisión diagnóstica de 81,32. Para la detección de la hemorragia vítrea, una sensibilidad y especificidad del 87,5 y 98,5%, respectivamente.ConclusionesEl ST diagnosticado por EO discrimina pacientes neurocríticos de extrema gravedad que pueden requerir el máximo escalón terapéutico y es un factor independiente de mortalidad intrahospitalaria. (AU)

Introduction: Terson syndrome (TS) is defined as any intraocular haemorrhage identified in patients with acute intracranial pathology. TS appears to be associated with clinical severity in patients with subarachnoid haemorrhage (SAH), but the association is yet to be defined in patients with traumatic brain injury (TBI) and intracerebral haemorrhage (ICH). This study aimed to evaluate the diagnostic performance of ocular ultrasound (OU) and its usefulness in clinical practice.Material and methodsWe performed an observational, prospective, single-centre study of neurocritical care patients. We analysed cases and controls, defined according to indirect ophthalmoscopy (IO) and OU findings. We determined the diagnostic characteristics of OU. A multivariate analysis was performed to identify clinically relevant associations.ResultsThe sample included 91 patients diagnosed with ICH (41.76%), SAH (29.67%), and TBI (28.57%). TS was identified by OU in 8 patients (8.79%) and by IO in 24 (24.37%). The adjusted mortality rate in patients with TS showed an odds ratio (OR) of 4.15 (95% confidence interval [CI], 1.52-11.33). All patients with TS detected by OU presented Glasgow Coma Scale scores < 9, with an elevated risk of needing decompressive craniectomy (OR: 9.84; 95% CI, 1.64-59). OU presented an overall sensitivity of 30.43%, specificity of 98.53%, and diagnostic accuracy of 81.32%. For the detection of vitreous haemorrhage, sensitivity and specificity were 87.5% and 98.5%, respectively.ConclusionsOU diagnosis of TS identifies extremely critical patients, who may require the highest level of care; TS is an independent risk factor for in-hospital mortality. (AU)

Ultrasound diagnosis of Terson syndrome as an indicator of extreme severity in neurocritical care patients.

INTRODUCTION: Terson syndrome (TS) is defined as any intraocular haemorrhage identified in patients with acute intracranial pathology. TS appears to be associated with clinical severity in patients with subarachnoid haemorrhage (SAH), but the association is yet to be defined in patients with traumatic brain injury (TBI) and intracerebral haemorrhage (ICH). This study aimed to evaluate the diagnostic performance of ocular ultrasound (OU) and its usefulness in clinical practice. MATERIAL AND METHODS: We performed an observational, prospective, single-centre study of neurocritical care patients. We analysed cases and controls, defined according to indirect ophthalmoscopy (IO) and OU findings. We determined the diagnostic characteristics of OU. A multivariate analysis was performed to identify clinically relevant associations. RESULTS: The sample included 91 patients diagnosed with ICH (41.76%), SAH (29.67%), and TBI (28.57%). TS was identified by OU in 8 patients (8.79%) and by IO in 24 (24.37%). The adjusted mortality rate in patients with TS showed an odds ratio (OR) of 4.15 (95% confidence interval [CI], 1.52-11.33). All patients with TS detected by OU presented Glasgow Coma Scale scores < 9, with an elevated risk of needing decompressive craniectomy (OR: 9.84; 95% CI, 1.64-59). OU presented an overall sensitivity of 30.43%, specificity of 98.53%, and diagnostic accuracy of 81.32%. For the detection of vitreous haemorrhage, sensitivity and specificity were 87.5% and 98.5%, respectively. CONCLUSIONS: OU diagnosis of TS identifies extremely critical patients, who may require the highest level of care; TS is an independent risk factor for in-hospital mortality.

Utilidad de la ecografía de la vaina del nervio óptico en pacientes con cese de flujo cerebral / Usefulness of the optic nerve sheath ultrasound in patients with cessation of cerebral flow

La ecografía del diámetro de la vaina del nervio óptico (DVNO), ha demostrado ser una herramienta útil para la detección de hipertensión intracraneal (HIC). Los valores del DVNO en pacientes con cese del flujo sanguíneo cerebral (CFSC), todavía no han sido definidos. Objetivo: Establecer asociación entre el DVNO y el CFSC en pacientes neurocríticos ingresados en una unidad de uidados intensivos (UCI). Pacientes y métodos: Estudio transversal de pacientes ingresados en una UCI polivalente de tercer nivel, con patología neurológica, entre abril de 2017 y abril de 2018. Se incluyeron en el estudio pacientes con signos de HIC o riesgo de desarrollarla, neurocríticos con alteraciones clínico radiológicas. Se realizó una ecografía del DVNO en las primeras 24 h de ingreso, que se repitió en aquellos pacientes con evolución a CFSC, establecido mediante Doppler transcraneal. Se compararon los valorares de DVNO de los pacientes con y sin diagnóstico de CFSC. Resultados: Se incluyeron 99 pacientes de los cuales 29 mostraron CFSC por Doppler transcraneal. La medición del DVNO no mostró diferencias significativas entre ambos grupos, 6,59 ± 0,75 en el grupo con CSFC y 6,39 ± 0,56 en el grupo sin CSFC, p = 0,141. Conclusión: En nuestro estudio, no se identificaron valores de DVNO capaces de diagnosticar el CFS (AU)

Optic nerve sheath diameter (ONSD) ultrasound has proven to be a useful tool for the detection of intracranial hypertension (IH). The ONSD values, in patients with cessation of cerebral blood flow (CCBF), has not been clarified yet. Objective: Establish an association between ONSD and CCBF in neurocritical patients admitted to an ICU. Patients and methods: Cross-sectional study of patients admitted in a third level ICU, between April 2017 and April 2018, with neurological pathology. ONSD ultrasound was performed in the first 24 hours and as the patient was diagnosed of CCBF. The ONSD values of patients with and without diagnosis of CCBF were compared. Results: 99 patients were included, 29 of whom showed CCBF in transcranial Doppler. The ONSD measurement did not demonstrate significant differences between both groups, 6,59 ± 0,75 in the group with CCBF and 6,39 ± 0,56 in the group without CCBF p=0.141. Conclusion: In our study, ONSD values capable of recognizing CCBF were not identified (AU)

Ultrasound diagnosis of Terson syndrome as an indicator of extreme severity in neurocritical care patients. / El síndrome de Terson diagnosticado por ecografía como indicador de extrema gravedad en pacientes neurocríticos.

INTRODUCTION: Terson syndrome (TS) is defined as any intraocular haemorrhage identified in patients with acute intracranial pathology. TS appears to be associated with clinical severity in patients with subarachnoid haemorrhage (SAH), but the association is yet to be defined in patients with traumatic brain injury (TBI) and intracerebral haemorrhage (ICH). This study aimed to evaluate the diagnostic performance of ocular ultrasound (OU) and its usefulness in clinical practice. MATERIAL AND METHODS: We performed an observational, prospective, single-centre study of neurocritical care patients. We analysed cases and controls, defined according to indirect ophthalmoscopy (IO) and OU findings. We determined the diagnostic characteristics of OU. A multivariate analysis was performed to identify clinically relevant associations. RESULTS: The sample included 91 patients diagnosed with ICH (41.76%), SAH (29.67%), and TBI (28.57%). TS was identified by OU in 8 patients (8.79%) and by IO in 24 (24.37%). The adjusted mortality rate in patients with TS showed an odds ratio (OR) of 4.15 (95% confidence interval [CI], 1.52-11.33). All patients with TS detected by OU presented Glasgow Coma Scale scores < 9, with an elevated risk of needing decompressive craniectomy (OR: 9.84; 95% CI, 1.64-59). OU presented an overall sensitivity of 30.43%, specificity of 98.53%, and diagnostic accuracy of 81.32%. For the detection of vitreous haemorrhage, sensitivity and specificity were 87.5% and 98.5%, respectively. CONCLUSIONS: OU diagnosis of TS identifies extremely critical patients, who may require the highest level of care; TS is an independent risk factor for in-hospital mortality.