Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Prevalence of Optic Nerve Head Edema in the ED

Neurology; ePub 2018 Jan 5; Sachdeva, et al

1 in 38 patients (2.6%) presenting to the emergency department (ED) with a chief complaint of headache, neurologic deficit, visual loss, or elevated blood pressure had optic nerve head edema (ONHE), a recent study found. Identification of ONHE altered patient disposition and contributed to the final diagnosis, confirming the importance of funduscopic examination in the ED. Cross-sectional analysis was done of patients with ONHE in the prospective Fundus Photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) study. Demographics, neuroimaging results, management, and patient disposition were collected. Researchers found:

  • Of 1,408 patients included, 37 (2.6%) had ONHE (median age 31 years, women 27 [73%], black 28 [76%]).
  • ONHE was bilateral in 27 of 37 (73%).
  • Presenting complaints were headache (18 of 37), visual loss (10 of 37), acute neurologic deficit (4 of 37), elevated blood pressure (2 of 37), and multiple (3 of 37).
  • The most common final diagnoses were idiopathic intracranial hypertension (19 of 37), cerebral spinal fluid shunt malfunction/infection (3 of 37), and optic neuritis (3 of 37).


Sachdeva V, Vasseneix C, Hage R, et al. Optic nerve head edema among patients presenting to the emergency department. [Published online ahead of print January 5, 2018]. Neurology. doi:10.1212/WNL.0000000000004895.

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