POCUS Eye – Hypertensive Crisis

A 71-year-old male with a history of CKD 4 presents to clinic with BP of 220/112. His examination is unremarkable with normal heart sounds and no crackles upon chest auscultation. His Cr is stable at his baseline of 2.8 and last UA was bland with no hematuria, just hyaline cast. Pt denies any complaints and reports that he just forgot to take his BP medications prior to coming to his appointment. We used our POC ultrasound to get the following image below.

There was no papilledema noted on our scan so we measured the optic nerve sheath diameter (ONSD). It was less than .5 cm (0.474cm) signifying that there was no increase in ICP so the patient was sent home. He took his antihypertensives and his blood pressure returned to normal.

When evaluating for possible elevation in intracranial pressure, it has been shown that optic nerve sheath diameter (ONSD) measurements correlate with elevated intracranial pressures. The optic nerve sheath is contiguous with the dura mater and has a trabeculated arachnoid space through which cerebrospinal fluid slowly percolates. The normal ONSD in adults is < 5mm.