4-week headache after 60 pints of beer

Abstract

In October, 2006, a 37-year-old man self-presented to our emergency department, with blurred vision and a persistent dull occipital headache, both of which had been present for 4 weeks. He had no other symptoms; there was no history of head injury or loss of con sciousness; his past medical history was unremark-able, and he was taking no regular medications. The patient was fully alert, had no fever, and his blood pressure was normal. Systemic examination, including a neurological examination, revealed nothing abnormal—except for fundoscopy, which was thought to show retinal haemorrhages.An ophthalmological opinion was requested. The patient described the “blurring” of his vision as consist-ing of episodes in which objects looked “wavy”. On examination, visual acuity was preserved at 6/5 in both eyes, and there was no relative aff erent pupillary defect. The visual fi elds had generalised constriction, and greatly enlarged blind spots. Repeat fundoscopy showed swollen optic discs with nerve fi bre layer haemorrhages (“fl ame haemorrhages”), consistent with papilloedema (fi gure)—signifying raised intracranial pressure (ICP). In the absence of any features of other syndromes that cause raised ICP, we suspected idiopathic intracranial hypertension (IIH). We sought a more detailed history. The patient revealed that, after a domestic crisis, he had consumed about 60 pints of beer in 4 days. His symp-toms had begun immediately after the binge. He had also experienced severe headache and vomiting for a day after the binge, but had attributed these to a bad hang over. The apparent onset of raised ICP, at a time of dehydrating alcohol consumption,