Optic Nerve Sheath Diameter Cutoff Point for Detection of Increased Intracranial Pressure in the Emergency Department

BACKGROUND: Ultrasound of the optic nerve sheath diameter (ONSD) is one of the most widely used noninvasive methods of screening for high intracranial pressure. AIM: This study aimed to measure the ONSD and to find the appropriate cutoff point to indicate increased intracranial pressure. METHODS: We examined 93 participants over 18 years of age with abnormal neurologic signs or symptoms and took computerized tomography (CT) scans of their brains. We measured the ONSD through ultrasound with the head positioned at 30°. We also used a linear array probe to measure the ONSD in the position after connecting the eyeball 3 mm. RESULTS: The average of the ONSD at each side was 4.76 mm (95% confidence interval [CI]: 4.65–4.87) in the normal CT scan group and 5.33 mm (95% CI: 5.13–5.33) in the abnormal CT scan (indicating high intracranial pressure) group. An ONSD cutoff point of 5.0 mm yielded 74.14% sensitivity and 49.22% specificity. The positive predictive value was 0.38 and negative predictive value was 0.82. CONCLUSION: The ONSD in the abnormal CT scan group was greater than in the normal CT scan group, and an ONSD of 5.0 mm can be used as a cutoff point for detecting increased intracranial pressure

Aromatherapy Reduces Anxiety in Unexperienced Patients Hospitalized for Interventional Neuroradiology Procedures: A Randomized Control Trial

The hospitalization and the unfamiliar experiences of patients in interventional radiology procedures cause a moderate to high levels of anxiety. This study was aimed to evaluate the anxiolytic effect of Cananga odorata essential oil (COE) aromatherapy in unexperienced patients hospitalized for interventional neuroradiology (INR) procedures. Forty-four patients admitted for their first INR procedure were randomly divided into COE and placebo control groups. COE or distilled water was dropped onto 2 pieces of mulberry paper and attached to the participant's gown at the shoulder level overnight. The main outcomes were observed from the morning salivary cortisol levels and salivary alpha-amylase activity after intervention. The Thai version of Spielberger State-Trait Anxiety Inventory (STAI) and the vital signs (blood pressure and heart rate) were also assessed before and after COE intervention as the secondary outcome. The demographic and baseline data of both groups did not show any significant difference. After intervention, COE group had a significantly lower salivary alpha-amylase activity than placebo control group. The post-intervention scores of Trait (STAI-T) and State (STAI-S) anxiety were significantly less than those of baseline in both groups. Interestingly, the COE group had a greater percentage reduction on STAI-T after intervention than placebo control group. No significant difference was observed in other outcomes. In addition, the salivary alpha-amylase activity was weak but showed significant correlation with STAI anxiety scores. This study indicates that COE aromatherapy reduces the saliva alpha amylase activity and STAI-T anxiety in unexperienced patients hospitalized for INR procedures