Idiopathic intracranial hypertension with initial presentation of optic disc edema

Abstract

Abstract Introduction: Idiopathic intracranial hypertension (IIH) is a disorder of elevated intracranial pressure in young women of childbearing age. The typical symptom is headache, and the symptom of visual obscuration tends to be overlooked. So, the patients usually visit the department of neurology for headache management. Here, we report a patient with IIH who first presented with ophthalmic symptoms. Patient concerns: A 28-year-old overweight female complained of intermittent darkened vision in both eyes lasting for 2 months. She was diagnosed with papilledema at another hospital and received local and systemic application administration of neurotrophic drugs and glucocorticoids 1 month before. Because of the poor outcomes, she visited our ophthalmology clinic for further management. She had no other medical history. Diagnosis: On ophthalmic examination, bilateral optic disc edema with blurred boundary was observed. The cranial magnetic resonance imaging and blood examination showed no obvious abnormality. A lumbar puncture was performed by a neurologist, which demonstrated an opening pressure of 30 cm of water. The cerebrospinal fluid biochemistry and bacteriology results were normal. A diagnosis of IIH was made based on the above findings. Outcomes: Oral acetazolamide, weight loss therapy and local corticosteroid treatment were initiated. At 7-week follow-up, the darkened vision and optic disc edema was obviously alleviated. Conclusion: IIH is a neurologic disease, but patients with this disease may first present to ophthalmology department because of the visual symptoms, such as blurred or darkened vision, visual loss, and even diplopia. As ophthalmologists, we should screen for this disease in a timely manner when we encounter similar patients with bilateral optic edema.