Selected Topics: Neurological Emergencies| Volume 57, ISSUE 2, P207-211, August 2019

Download started.


Acute Optic Neuritis Diagnosed by Bedside Ultrasound in an Emergency Department



      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.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Arnold A.C.
        Evolving management of optic neuritis and multiple sclerosis.
        Am J Ophthalmol. 2005; 139: 1101-1108
      1. The clinical profile of optic neuritis: experience of the Optic Neuritis Treatment Trial. Optic Neuritis Study Group.
        Arch Ophthalmol. 1991; 109: 1673-1678
        • Beck R.W.
        • Cleary P.A.
        • Backlund J.C.
        The course of recovery after optic neuritis. The experience of the Optic Neuritis Treatment Trial.
        Ophthalmology. 1994; 101: 1771-1778
        • Balcer L.J.
        Optic neuritis.
        N Engl J Med. 2006; 354: 1273-1280
        • Dees C.
        • Buimer R.
        • Dick A.D.
        • Atta H.R.
        Ultrasonographic investigation of optic neuritis.
        Eye. 1995; 9: 488-494
        • Tandon V.
        • Garg K.
        • Mahapatra A.K.
        An interesting case of wrongly diagnosed optic neuritis.
        Asian J Neurosurg. 2017; 12: 103-105
        • Weerasinghe D.
        • Lueck C.
        Mimics and chameleons of optic neuritis.
        Pract Neurol. 2016; 16: 96-110
        • Kupersmith M.J.
        • Alban T.
        • Zeiffer B.
        • Lefton D.
        Contrast-enhanced MRI in acute optic neuritis: relationship to visual performance.
        Brain. 2002; 125: 812-822
        • Kapoor R.
        • Miller D.H.
        • Jones S.J.
        • et al.
        Effects of intravenous methylprednisolone on outcome in MRI-based prognostic subgroups in acute optic neuritis.
        Neurology. 1998; 50: 230-237
        • Wakakura M.
        • Mashimo K.
        • Oono S.
        • et al.
        Multicenter clinical trial for evaluating methylprednisolone pulse treatment of idiopathic optic neuritis in Japan.
        Jpn J Ophthalmol. 1999; 43: 133-138
        • Sellebjerg F.
        • Nielsen H.S.
        • Frederiksen J.L.
        • Olesen J.
        A randomized, controlled trial of oral high-dose methylprednisolone in acute optic neuritis.
        Neurology. 1999; 52: 1479-1484
        • Wayman D.
        • Carmody K.A.
        Optic neuritis diagnosed by bedside emergency physician-performed ultrasound: a case report.
        J Emerg Med. 2014; 47: 301-305
        • Cardozo O.A.
        • Urrego J.L.A.
        Ultrasonido del nervio óptico en la neuritis óptica.
        Arch Med Urg Mex. 2011; 3: 121-123
        • Ashurst J.
        • Schofer J.
        • Sierzenski P.
        Unilateral papilledema: a case of optic neuritis diagnosed with bedside ocular sonography.
        Del Med J. 2010; 82: 137-139
        • Yee N.P.
        • Kashani S.
        • Mailhot T.
        • Omer T.
        More than meets the eye: point-of-care ultrasound diagnosis of acute optic neuritis in the emergency department.
        Am J Emerg Med. 2019; 37 (e1–e4): 177
      2. Ultrasound guidelines: emergency point-of-care and clinical ultrasound guidelines in medicine.
        Ann Emerg Med. 2017; 69: e27-e54
        • Hassen G.W.
        • Bruck I.
        • Donahue J.
        • et al.
        Accuracy of optic nerve sheath diameter measurement by emergency physicians using bedside ultrasound.
        J Emerg Med. 2015; 48: 450-457
        • Lochner P.
        • Cantello R.
        • Brigo F.
        • et al.
        Transorbital sonography in acute optic neuritis: a case-control study.
        AJNR Am J Neuroradiol. 2014; 35: 2371-2375
        • Lochner P.
        • Cantello R.
        • Fassbender K.
        • et al.
        Longitudinal assessment of transorbital sonography, visual acuity, and biomarkers for inflammation and axonal injury in optic meuritis.
        Dis Markers. 2017; 2017: 5434310
        • Bäuerle J.
        • Lochner P.
        • Kaps M.
        • Nedelmann M.
        Intra- and interobserver reliability of sonographic assessment of the optic nerve sheath diameter in healthy adults.
        J Neuroimaging. 2012; 22: 42-45
        • Lochner P.
        • Leone M.A.
        • Coppo L.
        • et al.
        B-mode transorbital ultrasonography for the diagnosis of acute optic neuritis. A systematic review.
        Clin Neurophysiol. 2016; 127: 803-809

      Linked Article