Badron Junaidah, Ong Gene Yong-Kwang
Children's Emergency, KK Women's and Children's Hospital, Singapore.
J Emerg Med. 2019 Apr;56(4):417-420. doi: 10.1016/j.jemermed.2018.12.042. Epub 2019 Feb 10.
Headache and monocular visual disturbance are worrisome pediatric presenting complaints in the emergency department. Appropriate and timely initial evaluation is critical. Most would opt for urgent computer tomography in such cases. Pediatric optic neuritis is a rare condition and is better evaluated by magnetic resonance imaging. With the increase in the use and scope of bedside ultrasound, there might be a potential role for transorbital ultrasound to be part of the emergency department evaluation of pediatric optic neuritis.
This is the first pediatric case report on the use of bedside transorbital ultrasound in the emergency department evaluation of a 15-year-old girl with optic neuritis who presented with unilateral headache and left visual disturbance. Transorbital ultrasound of her left eye revealed an irregularly enlarged optic nerve sheath with increased optic nerve sheath diameter (5.1 mm) and an elevated optic disc height (0.5 mm). Ultrasound examination of her right eye was contrastingly normal, showing an optic nerve sheath diameter of 3.8 mm and that the optic disc was not elevated. The ultrasound findings correlated well with her magnetic resonance imaging of her orbits. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The clinical findings and monocular ultrasound abnormalities facilitated the emergency department decision-making process and choice of neuroimaging. This highlights the use of transorbital ultrasound as a clinical adjunct and potential role in the emergency department clinical evaluation of a pediatric patient with optic neuritis. The finding of an irregularly enlarged optic nerve might be of potential clinical value but further studies are required.
头痛和单眼视觉障碍是儿科急诊中令人担忧的就诊主诉。进行恰当且及时的初步评估至关重要。在这种情况下，大多数人会选择紧急计算机断层扫描。小儿视神经炎是一种罕见病症，通过磁共振成像评估效果更佳。随着床边超声使用的增加及其范围的扩大，经眶超声在小儿视神经炎的急诊科评估中可能具有潜在作用。
这是首例关于在急诊科对一名15岁视神经炎女孩进行评估时使用床边经眶超声的儿科病例报告，该女孩出现单侧头痛和左眼视觉障碍。对其左眼进行经眶超声检查发现视神经鞘不规则增大，视神经鞘直径增加（5.1毫米），视盘高度升高（0.5毫米）。相比之下，对其右眼的超声检查正常，显示视神经鞘直径为3.8毫米，视盘未升高。超声检查结果与其眼眶磁共振成像结果高度相关。急诊医生为何应知晓此事？：临床发现和单眼超声异常有助于急诊科的决策过程及神经影像学检查的选择。这凸显了经眶超声作为一种临床辅助手段在小儿视神经炎患者急诊科临床评估中的潜在作用。视神经不规则增大这一发现可能具有潜在临床价值，但还需要进一步研究。
