Idiopathic Intracranial Hypertension (IIH) is an increasingly common condition that usually presents with younger obese female patients. Studies report between 74-94% of patients with a BMI>30,1–595% with ages under 50 (7) and over 87-91% of the patients being overwhelmingly females.8 9
In this case report, we present a 66-year-old man with a BMI of 24.7 kg/m2 who was referred by his ophthalmologist with bilateral papilledema on the ophthalmic examination and OCTs. The 30-2 Humphrey Visual Field testing showed significant loss of his inferior field on the right side. There were also early field losses noted on the left side. Lumbar puncture showed a borderline elevated CSF opening pressure of 25 cmH2O. Initial and subsequent MRI brain and orbits have shown constellation of findings consistent with idiopathic intracranial hypertension. Extensive investigations were carried out to identify any secondary cause. These included CT venogram, CT neck, chest abdomen and pelvis, serum and CSF testing for inflammatory/autoimmune, paraneoplastic, infectious and metabolic causes. His non-compliance with Acetazolamide led to clinical deterioration and optic atrophy on the right side. After 2 years of the onset, the patient is clinically stable on 250 mg TDS of Acetazolamide with normal CSF opening pressure on repeat testing recently.
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