Effects of Age and Sex on Optic Nerve Sheath Diameter in Healthy Volunteers and Patients With Traumatic Brain Injury

Danilo Cardim; Marek Czosnyka; Karthikka Chandrapatham; Rafael Badenes; Alessandro Bertuccio; Anna Di Noto; Joseph Donnelly; Paolo Pelosi; Lorenzo Ball; Peter J Hutchinson; Chiara Robba

doi:10.3389/fneur.2020.00764

Effects of Age and Sex on Optic Nerve Sheath Diameter in Healthy Volunteers and Patients With Traumatic Brain Injury

Front Neurol. 2020 Aug 7:11:764. doi: 10.3389/fneur.2020.00764. eCollection 2020.

Authors

Danilo Cardim^{1

2

3}, Marek Czosnyka^{1

4}, Karthikka Chandrapatham⁵, Rafael Badenes⁶, Alessandro Bertuccio⁷, Anna Di Noto⁸, Joseph Donnelly^{1

9}, Paolo Pelosi^{8

5}, Lorenzo Ball^{8

5}, Peter J Hutchinson¹⁰, Chiara Robba^{1

8}

Affiliations

¹ Brain Physics Laboratory, Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.
² Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, TX, United States.
³ Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, United States.
⁴ Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland.
⁵ Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
⁶ University of Valencia Hospital Clinic, Anesthesiology and Surgical-Trauma Intensive Care, Valencia, Spain.
⁷ Department of Neurosurgery, S. Cesare, Arrigo, Antonio, Biagio, Alessandria, Italy.
⁸ Anaesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, University of Genoa, Genoa, Italy.
⁹ Department of Anesthesiology, University of Auckland, Auckland, New Zealand.
¹⁰ Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom.

Abstract

The measurement of optic nerve sheath diameter (ONSD) has been reported as a non-invasive marker for intracranial pressure (ICP). Nevertheless, it is uncertain whether possible ONSD differences occur with age and sex in healthy and brain-injured populations. The aim of this study was to investigate the effects of sex and age on ONSD in healthy volunteers and patients with traumatic brain injury. We prospectively included 122 healthy adult volunteers (Galliera Hospital, Genova, Italy), and compared age/sex dependence of ONSD to 95 adult patients (Addenbrooke's Hospital, Cambridge, UK) with severe traumatic brain injury (TBI) requiring intubation and invasive ICP monitoring. The two groups were stratified for sex and age. Age was divided into 3 subgroups: (1) young adults: 18-44 years; (2) middle-aged adults: 45-64 years; (3) old adults: >65 years. In healthy volunteers, ONSD was significantly different between males and females [median (interquartile range): 4.2 (3.9-4.6) mm vs. 4.1 (3.6-4.2) mm (p = 0.01), respectively] and was correlated with age (R = 0.50, p < 0.0001). ONSD was significantly increased in group 3 compared to groups 2 and 1, indicating that ONSD values are higher in elderly subjects. In TBI patients, no differences in ONSD were found for sex and the correlation between ONSD and age was non-significant (R = 0.13, p = 0.20). ONSD increases with age and is significantly larger for males in healthy volunteers but not in TBI patients. Different ONSD cut-off values need not be age- or sex-adjusted for the assessment of increased ICP in TBI patients.

Keywords: healthy volunteers; intracranial pressure; optic nerve sheath diameter; traumatic brain injury; ultrasonography.