2026 American Academy of Neurology Abstract Website

Objective:

To report our >2-year experience evaluating patients' final diagnoses and usefulness of tests performed as part of our Emergency Department (ED) "Papilledema Protocol".

Background:

Increasing Neuro-ophthalmology consultations in the ED prompted implementation of a “Papilledema Protocol” to streamline evaluation of patients with signs/symptoms of intracranial hypertension and/or bilateral disc edema [protocol performed in our ED/Clinical Decision Unit (CDU): non-mydriatic color-fundus photography/OCT nerve/macula (NMFP-OCT) by ED-staff/remote interpretation by Ophthalmology; Neurology/Neuro-ophthalmology consultations; contrast-MRI brain/orbits; MR-Venogram; lumbar puncture (CSF-opening pressure/analysis); blood pressure; CBC, ±syphilis testing].

Design/Methods:

Prospective quality improvement project of consecutive ED-patients with “Papilledema Protocol” from 6/14/2023-9/21/2025. We collected patient demographics, referral patterns, ancillary testing, final diagnoses, ED/CDU length-of-stay, disposition.

Results:

318 patients with remote diagnosis of “papilledema” on NMFP-OCT underwent “Papilledema Protocol” in our ED/CDU.

Referral patterns: presumed papilledema found by outside eye-care-providers (228;72%); papilledema found in our eye clinic (14;4%); symptoms/signs suggesting intracranial hypertension (75;24%); incidental bilateral disc edema in fungemia (1;0.3%).

211 (66.4%) were discharged home from the ED/CDU [median length-of-stay 27.9 hours, IQR,24.6-32.2]; 107 (33.6%) were admitted to the hospital.

Final diagnoses: idiopathic intracranial hypertension (223;70%) (6 fulminant IIH); cerebral venous thrombosis (7;2.2%); intracranial mass (3;0.9%); subdural hematoma (1); obstructive hydrocephalus (4;1.3%); CSF shunt malfunction (2;0.6%); leptomeningeal process (10;3.1%); stage-IV hypertensive retinopathy (7;2.2%); other anterior optic neuropathies (36;11.3%); pseudopapilledema (24;7.5%).

Workup obtained in the ED: head-CT (157;49.4%); contrast MRI-brain/orbits (254;79.9%); MRI-brain only (31;9.7%); head-MRV (272;85.5%); LP in ED (263;82.7%); 317 CBC.

309/318 (97%) patients required outpatient neuro-ophthalmology follow-up; 4 (1.2 %) patients returned to the ED for same concern within 30 days.

Conclusions:

Remote interpretation of NMFP-OCT obtained in the ED allowed for rapid trigger of “Papilledema Protocol” and expedited care. 77/318 (24.2%) patients with “Papilledema Protocol” in our ED/CDU were diagnosed with severe disorders; 33.6% required admission to the hospital. Only 1.2% of patients returned to the ED within 30 days