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Idiopathic Intracranial Hypertension — SCE Neurology MCQ

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HardHeadache & Facial PainIdiopathic Intracranial HypertensionSCE Neurology

A 28-year-old obese woman presents with progressive headaches, transient visual obscurations, and pulsatile tinnitus. Fundoscopy shows bilateral papilloedema. MRI brain and MRV are normal. Lumbar puncture opening pressure is 32 cmH₂O with normal CSF constituents. What is the first-line medical treatment?

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Correct answer: E — Acetazolamide

The best answer is “Acetazolamide”. IIH requires raised opening pressure with normal CSF composition and exclusion of secondary causes; management protects vision, addresses weight and uses pressure-lowering treatment with urgent surgery when vision is threatened. The alternatives “Topiramate”, “Furosemide”, “Dexamethasone”, “Gabapentin” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: Association of British Neurologists IIH consensus guideline: https://jnnp.bmj.com/content/89/10/1088