Acute Optic Neuritis Diagnosed by Bedside Ultrasound in an Emergency Department

J Emerg Med. 2019 Aug;57(2):207-211. doi: 10.1016/j.jemermed.2019.04.032. Epub 2019 Jun 20.

Abstract

Background: Transorbital ultrasound was used to diagnose acute optic neuritis (AON) at bedside in an emergency department (ED).

Case report: A 59-year-old female patient presented to an ED after 7 days of progressive unilateral visual loss while she was receiving outpatient treatment for relapsing-remitting multiple sclerosis. Transorbital ultrasound revealed a disparity between the optic nerve sheath diameters of the affected and nonaffected eyes and striking optic nerve edema in the affected eye. These findings led to a diagnosis of AON and early definitive treatment. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Given an absence of reliable diagnostic criteria for AON, comorbidity with multiple sclerosis, and limitations inherent to magnetic resonance imaging, transorbital sonography may facilitate diagnosis of this condition in emergent presentations.

Keywords: acute optic neuritis; edema; multiple sclerosis; optic nerve diameter; optic nerve sheath diameter; transorbital ultrasound.

Publication types

  • Case Reports

MeSH terms

  • Blindness / diagnostic imaging
  • Blindness / etiology
  • Emergency Service, Hospital / organization & administration
  • Female
  • Headache / diagnostic imaging
  • Headache / etiology
  • Humans
  • Middle Aged
  • Optic Neuritis / diagnosis
  • Optic Neuritis / diagnostic imaging*
  • Point-of-Care Systems
  • Ultrasonography / methods*