TY  - BOOK
AU  - Muniko Albert
AU  - Rodrick Kabangila
AU  - Riaz Aziz
AU  - Justine Kingery
TI  - Prevallence and Outcome of Raised Intracranial Pressure as Determined by Optic Nerve Sheath Diameter in Suspected Stroke Patients Admitted to Bugando Medical Centre, Mwanza Tanzania
PY  - 2018///
CY  - Mwanza, Tanzania  
PB  - Catholic University of Health and Allied Sciences CUHAS - Bugando
KW  -  
N2  - Abstract:

Background: Raised Intracranial pressure (ICP) is associated with poor outcomes. Diagnostic and surveillance tests are not readily available in resource-limited settings. Optic nerve sheath diameter (ONSD) as determine by transoptic ultrasound, has been proven to correlate with raising ICP. Data is lacking regarding the collection of increased ultrasound obtained ONSD and outcomes in resource-limited settings. 

Objective: To determine prevalence and outcomes of raised ICP as determined by ONSD in suspected stroke patients admitted to Bugando Medical Centre.

Methodology: ONSD of patients admitted to the medical wards with an admission diagnosis of suspected stroke was measured within 24 hours of admission. Participants were followed for 30 days, or until death/hospital discharge. ONSD of a normal population control group was also measured and used as a baseline.

Results: The median control group ONSD was 4.40mm (4.00-4.98). Sex was significantly associated with average ONSD in the control group, with males having higher baseline ONSD (4.6mm vs 4.36mm, respectively) (p<0.001). The median ONSD in suspected stroke patients was 4.66mm, ranging from 3.95mm to 5.88mm. The difference in median ONSD in suspected stroke patients and control group was statistically significant (P value = 0.018). Twenty-five percent of all suspected stroke patients presented with raised ICP by the study definition of ONSD ≥5.0mm. Nearly half (45.4%) of suspected stroke patients who had raised ICP died compared to 27.7% of stroke patients with normal ICP (P=0.262). The median ONSD on admission is suspected stroke who survived was smaller (4.65mm) as compared to those who died (4.7mm) (p=0.351). Among suspected stroke survivors, the median duration of hospital stay was 3 times longer in those who had raised ICP at 14 days as compared to those who had normal ICP (P value = 0.005).

Conclusion: The control group ONSD is similar to other populations. Additionally, normal Tanzanian males have statistically higher ONSD as compared to females. Suspected stroke patients at Bugando Medical Centre presented with significant increase in ICP compared to the control group. An ONSD of 5.0mm and above in suspected stroke patients was associated with increased morbidity as shown by prolonged hospital stay among stroke survivors. The same ONSD cut off point is associated with borderline significance increase in mortality

ER  -