Some Emergency Department Patients with Headache Have Abnormal Fundi on Photographic Exam

An abnormal fundus may identify a serious underlying cause of headache. In this prospective cross-sectional study of 497 patients who presented to an academic emergency department (ED) with headache and underwent nonmydriatic fundus photography, researchers identified factors associated with abnormal findings. All photographs were examined independently by two neuro-ophthalmologists.

Forty two patients (8.5%) had abnormal findings on photographic examination: isolated retinal hemorrhage (15), disc edema (12; bilateral in 11), optic nerve pallor (9), and grade III/IV hypertensive retinopathy (6). Of 28 patients who underwent direct funduscopic exam by an emergency physician, 4 had abnormal findings on photographic exam that were not detected …