Ocular ultrasound lowers threshold for lumbar puncture in varicella zoster virus meningitis: A case report.

Headache is a common presenting concern among patients presenting to the emergency department, with etiologies ranging from benign primary headaches to potentially life-threatening intracranial infection, hemorrhage, or mass lesions. Ocular ultrasound can rapidly and noninvasively detect papilledema, making it a valuable first-line tool for guiding diagnosis and management decisions. We describe a case of an otherwise healthy 37-year-old female who presented to the emergency department with a five-day history of headache. She had previously been evaluated at two other emergency departments, where laboratory testing and non-contrast head computed tomography were unremarkable, and was discharged on both occasions. During this third visit, ocular ultrasound demonstrated papilledema, leading to a lumbar puncture that confirmed a diagnosis of varicella zoster virus meningitis. Ocular ultrasound is widely available and easy to perform, allowing physicians to rapidly distinguish serious causes of headache from the many benign causes. Given the finite resources and time of an emergency physician, using this quick imaging technology may help direct the utilization of more invasive testing, such as lumbar puncture or neuroimaging, and improve diagnostic accuracy.