Effect of Magnesium Sulphate on Optic Nerve Sheath Diameter as an Indirect Measure of Intra-Cranial Pressure: A Case Study of Eclampsia Patients
DOI:
https://doi.org/10.21649/akemu.v30i4.5615Keywords:
Intracranial Pressure, Eclampsia, Magnesium sulphate therapy, ONSD (optic nerve sheath diameter)Abstract
Background: Eclampsia is associated with increased intracranial pressure (ICP). Magnesium sulphate (MgSO4) is the usual treatment and is linked to a significant decrease in cerebral perfusion pressure (CPP) as well as the avoidance of brain injury. There are various invasive procedures which are still the gold standard for monitoring intracranial pressure (ICP), however, they are not always practical or easily available choices. Therefore, a non-invasive promising tool can be used to reflect variations in the intracranial pressure is optic nerve sheath diameter (ONSD) assessment using ultrasonography.
Objective: This study aims to measure changes in the Optic nerve sheath diameter in order to identify the impact of magnesium sulphate treatment; a proxy for elevated intracranial pressure in eclampsia patients.
Methods: In this pilot study the data was collected from sixty pregnant female patients with all signs and symptoms of eclampsia. The analysis of optic nerve sheath diameter was done using ultrasound prior to the start of magnesium sulphate treatment and then was measured after 01, 06 and 24 hours.
Results: The mean diameter of optic nerve sheath in women was high at baseline time point and they were presented with hypertension and disturbed vision. At one, six and twenty-four hours of taking magnesium sulphate, there was a statistically significant decrease in the mean optic nerve sheath diameter values. However, there is insignificant relationship between mean arterial pressure and optic nerve sheath diameter.
Conclusion: This study concludes that a high optic nerve sheath diameter value, indicative of elevated intracranial pressure, was present in the majority of study participants who were significantly eclamptic. This condition was significantly impacted by magnesium sulphate medication. Thus, ultrasound can be used as a convenient, affordable, point-of-care bedside technology to indirectly measure intracranial pressure in this high-risk group.
References
Chhabra S, Kumar N, Tejane H. Awareness of eclampsia among rural tribal women of reproductive age. Int. J. Gynecol. Obstet. 2024; 165 (2): 756-763. doi:10.1002/ijgo.15320.
Leonard SA, Carmichael SL, Main EK, Lyell DJ, Abrams B. Risk of severe maternal morbidity in relation to prepregnancy body mass index: Roles of maternal co-morbidities and caesarean birth. Paediatr. Perinat. Epidemiol. 2020;34(4):460-468. doi: 10.1111/ppe.12555.
Wang L, Di J, Wang Q, Zhang H, Zhao W, Shi X, et. al. Heat exposure induced risks of preterm birth mediated by maternal hypertension. Nat. Med. 2024; 30(7):1974-1981. doi: 10.1038/s41591-024-03002-w.
Macedo TCC, Montagna E, Trevisan CM, Zaia V, de Oliveira R, Barbosa CP, et al. Prevalence of preeclampsia and eclampsia in adolescent pregnancy: A systematic review and meta-analysis of 291,247 adolescents worldwide since 1969. Eur. J. Obstet. Gynecol. Reprod. Biol. 2020; 248(1): 177-86. https://doi.org/10.1016/j.ejogrb.2020.03.043.
Vousden N, Lawley E. Incidence of eclampsia and related complications across 10 low- and middle-resource geographical regions: Secondary analysis of a cluster randomised controlled trial. PLoS Med. 2019;16(3):1-15. https://doi.org/10.1371/journal.pmed.1002775
Wang L, Zhang C, Di L, Wang Q, Ren M, Huang A, et. al. Increased risk of preterm birth due to heat exposure during pregnancy: Exploring the mechanism of fetal physiology. Sci. Total Environ. 2024; 931(1): 172730. doi:10.1016/j.scitotenv.2024.172730.
Fishel Bartal M, Sibai BM. Eclampsia in the 21st century. Am. J. Obstet. Gynecol. 2022; 226(2): 1237-53.
Chappell LC, Cluver CA, Kingdom J, Tong S. Pre-eclampsia. Lancet (London, England). 2021;398(10297):341-54.
Tejaswi MS, Kanthi MJ, Vinya P, Bhaskaran R. Urine Calcium-Creatinine Ratio in Prediction of Pre-eclampsia. J. Obstet. Gynaecol. India. 2023;73(1):51-56. doi:10.1007/s13224-022-01712-0.
Simenc GB, Ambrozic J, Prokselj K, Tul N, Cvijic M, Mirkovic T, et al. Ocular ultrasonography for diagnosing increased intracranial pressure in patients with severe preeclampsia. Int. J. Obstet. Anesth. 2018;36(1):49-55.
Hanafi MG, Verki MM, Parei SN. Ultrasonic Assessment of Optic Nerve Sheath to Detect Increased Intracranial Pressure. J Med Ultrasound. 2019;27(2):69-74. doi:10.4103/JMU.JMU-54-18.
Kim S-E, Hong EP, Kim HC, Lee SU, Jeon JP. Ultrasonographic optic nerve sheath diameter to detect increased intracranial pressure in adults: a meta-analysis. Acta Radiol. 2019;60(2):221-9.
Evensen KB, Eide PK. Measuring intracranial pressure by invasive, less invasive or non-invasive means: limitations and avenues for improvement. Fluids Barriers CNS. 2020;17(1):1-33. doi:10.1186/s12987-020-00195-3.
Biswas J, Khatun N. Optic nerve sheath diameter measurements using ultrasonography to diagnose raised intracranial pressure in preeclampsia: an observational study. J. Turk. Ger. Gynecol. Assoc. 2023;24(1):5-11.
Liu Y, Li D, Wang Y, Qi H, Wen L. Impact of Gestational Diabetes and Hypertension Disorders of Pregnancy on Neonatal Outcomes in Twin Pregnancies Based on Chorionicity. J Clin Med. 2023;12(3):1-10. doi:10.3390/jcm12031096.
Tang S, Liu Y, Gu Y, Yang Q, Wang Q. Effects of electronic screen exposure time on hypertensive disorders in pregnancy: a retrospective cohort study. BMC public health. 2024;24(1):1-8. https://doi.org/10.1186/s12889-024-18793-3.
Omran AS, El Ansari T, Riad W. Effect of magnesium sulphate on the intracranial pressure of preeclampsia patients using ultrasound-guided optic nerve sheath diameter: A pilot study. Saudi J. Anaesth. 2021;15(1):14-8.
Kshirsagar SJ, Pande AH, Naik SV, Yadav A, Sakhala RM, Salve SM, et al. Bedside ultrasonographic evaluation of optic nerve sheath diameter for monitoring of intracranial pressure in traumatic brain injury patients: a cross sectional study in level II trauma care center in India. Acute Crit. Care. 2024;39(1):155-61.
Weidner N, Kretschmann J, Bomberg H, Antes S, Leonhardt S. Real-Time Evaluation of Optic Nerve Sheath Diameter (ONSD) in Awake, Spontaneously Breathing Patients. J. Clin. Med. 2021;10(16):1-9. doi:10.3390/jcm10163549.
Müller SJ, Henkes E, Gounis MJ, Felber S, Ganslandt O, Henkes H. Non-Invasive Intracranial Pressure Monitoring. J. Clin. Med. 2023;12(6): 1-27. 9. https://doi.org/
3390/jcm12062209.
Bala R, Banerjee A, Taxak S, Kumar R. Optic Nerve Sheath Diameter Measured Using Ocular Sonography is Raised in Patients With Eclampsia. Int. J. Obstet. Anesth. 2019;9(2): 65-69. doi: 10.4103/joacc.JOACC-1-19
Assu SM, Bhatia N. Sonographic Optic Nerve Sheath Diameter Following Seizure Prophylaxis in Pre-Eclamptic Parturients With Severe Features: A Prospective, Observational Study. J. Ultrasound Med. 2021;40(11):2451-7.
Shields LE, Wiesner S, Klein C, Pelletreau B, Hedriana HL. Early standardized treatment of critical blood pressure elevations is associated with a reduction in eclampsia and severe maternal morbidity. Am. J. Obstet. Gynecol. 2017; 216(4):415. 1-5.
Bakrania BA, George EM, Granger JP. Animal models of preeclampsia: investigating pathophysiology and therapeutic targets. Am. J. Obstet. Gynecol. 2022; 226(2):973-87.
Dhandapani S, Aditya G, S V, Sharma B, Ak M. Randomized controlled trial of magnesium sulphate in severe closed traumatic brain injury. Indian J. Neurotrauma. 2008;5 (1): 27-33. https://doi.org/10.1016/S0973-0508(08)80025-1.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Annals of King Edward Medical University
This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments publications@kemu.edu.pk