الفهرس 
List of contentOnly 14 pages are availabe for public view
 |  | from | 85 |  |  |
| | | from | 85 | | |
Abstract
Raised intracranial pressure (ICP) is a common life-threatening condition that can occur in multiple neurological or non-neurological settings. There is a multiple methods to monitor the intracranial pressure either invasive or non invasive. Several non-invasive methods also have been developed in order to propose an alternative to invasive method, such as neuroimaging , ophthalmoscopy and transcranial doppler sonography. However, this method have multiple advantages being noninvasive and without complication but unfortunately, each of these techniques has drawbacks. Interestingly, the optic nerve sheath diameter (ONSD) was reported to be increased in patients with intracranial hypertension. and ONSD demonstrated a good correlation with the ICP level in many previously published studies.Previous reports have indicated that direct measurement of the ONSD is possible by optic nerve sonography and may be applied in brain-injured patient to detect elevated ICP in static conditions. Patient with increased intracranial pressure need multiple intervention to decrease the intracranial pressure one of them is mannitol osmotherapy. these interventions needs continous monitoring of dynamic intracranial pressure. For this purpose we conducted this observational study on 80 patients with TBI that were admitted to Mansoura University Emergency Hospital of both sex for monitoring of dynamic changes of ONSD in response of mannitol osmotherapy. After admission all patients characterstics data were obtained ( age, sex, diagnosis) then evaluated haemodynamically ( heart rate , blood pressure, respiratory rate and oxygen saturation), neurologically by Glasgow coma scale (GCS), all patient with GCS≤ 9 were intubated. consequently head CT scans were performed to evaluate possible brain injury. Based on the head CT scan results, the severity of brain injury will be classified according to a semiquantitative neuroimaging Marshall scale. After that all patients were examined by ultrasound to monitor ONSD. we used a cut off value for ONSD as 4.8 mm to diagnose ICP> 20 mm hg. all patients with signs of increased ICP had received mannitol 20 % in a dose of 0.5 gm /kg every 6 hours for 48 hours slowly over a period of 20 minutes. After the end of this study we found a significant reduction of ONSD after mannitol osmotherapy with peak effect after 20 minutes. Also we found a significant improvement of GCS and Marshall scale after mannitol osmotherapy with peak effect after 48 hours. We found a significant correlation between ONSD, GCS and Marshall scale before and after mannitol osmotherapy. There was a significant increase in heart rate after mannitol therapy. also there was a significant reduction in mean arterial pressure after mannitol osmotherapy. At the end of our study we stated that ONSD sonography is a useful and user-friendly, noninvasive tool to detect ICP elevation, and ONSD is well correlated with ICP. Under dynamic conditions, this correlation remains valid even after osmotherapy with mannitol. Accordingly, ONSD sonography may be useful for monitoring efficacy of osmotherapy challenges during episodes of elevated ICP, particularly in the emergency room when invasive ICP monitoring is unavailable.also the correlation between ONSD, Marshall scale and GCS make it a reliable method for assessing the severity and prognosis of the disease state.