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).

Citation:

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.

This Week's Must Reads

MS Risk Factors Contribute to Onset Heterogeneity, Mult Scler Relat Disord; ePub 2018 Dec 3; Briggs, et al

Severe Fatigue in MS Predicts EDSS Worsening, Mult Scler; ePub 2018 Dec 3; Vaughn, et al

Cerebrospinal Fluid Biomarkers and MS Severity, Mult Scler Relat Disord; ePub 2018 Dec 5; Masvekar, et al

Research-to-Practice Gaps in Multiple Sclerosis, Int J MS Care; ePub 2018 Nov 27; Walker, et al

Head Trauma, Autoimmune Diseases: No Link with MS , Neuroepidemiol; ePub 2018 Nov 26; Abdollahpour, et al

Must Reads in Headache & Migraine

FDA Approves Ajovy for Migraine in Adults, Teva Pharmaceutical news release; 2018 Sep 14

Headache Patients Seek High Level of Outpatient Care , Headache; ePub 2018 Jul 19; Brilla, Woo, et al

Prevalence of Optic Nerve Head Edema in the ED, Neurology; ePub 2018 Jan 5; Sachdeva, et al

Association Between Migraine and Suicidal Behavior, Headache; ePub 2017 Nov 29; Friedman, Zhong, et al

Features of SAH Headache Are Distinct from Others, Headache; ePub 2017 Nov 4; Mac Grory, et al