2025 American Academy of Neurology Abstract Website

Objective:

To demonstrate the utility of rapid bedside ocular ultrasound during a stroke alert in informing TNK treatment decisions.

Background:

Ocular ultrasound offers detailed imaging of the posterior segment of the eye, aiding in the assessment of visual deficits of unclear etiology. This can be particularly beneficial in cases with optical opacities or for evaluating deeper tissue structures that could cause the visual deficit or pose a relative contraindication to IV Thrombolytic administration.

Design/Methods:

An 86-year-old female presented to the Emergency Department with a sudden onset of a “black cloud” over the superior aspect of her right eye, both temporally and nasally. She had an NIHSS score of 1 for a partial visual deficit (blurred vision in the right superior nasal field). Due to concerns over a potentially disabling visual deficit, she was considered a candidate for IV Tenecteplase, with less than one hour remaining in the treatment window.

Results:

Her head CT scan showed no hemorrhage, but due to concerns for a possible intraocular hemorrhage, a bedside ocular ultrasound was performed by an Emergency Department attending physician. The ultrasound suggested a likely vitreous hemorrhage, and she was no longer considered a candidate for IV TNK. The presence of the hemorrhage was later confirmed by a dilated eye exam performed by the ophthalmology team

Conclusions:

While ocular ultrasound is not routinely used in the initial evaluation of acute stroke, it represents a valuable tool for guiding decision-making during stroke alerts. Given the constraints of time and resources, an urgent ophthalmology consult is often not feasible. Bedside ocular ultrasound can help rule out retinal detachment or hemorrhage as the cause of acute visual symptoms, aiding neurologists and ED physicians in determining IV thrombolytic eligibility