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IIH – Acetazolamide Intolerance — SCE Neurology MCQ

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ModerateCerebrovascular DiseaseIIH – Acetazolamide IntoleranceSCE Neurology

A 42-year-old woman presents with a 2-week history of progressive headache, left-sided visual obscurations, and diplopia. She has bilateral papilloedema and a left 6th nerve palsy. MRI brain shows bilateral transverse sinus stenosis but no venous thrombosis. BMI is 42. LP opening pressure is 38 cmH₂O. CSF composition is normal. She is started on acetazolamide but develops intolerable paraesthesiae and metabolic acidosis. What is the most appropriate alternative medical therapy?

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Correct answer: D — Topiramate

The best answer is “Topiramate”. UK stroke guidance supports urgent vascular imaging and reperfusion selection, short-course dual antiplatelet therapy for eligible minor stroke or high-risk TIA, decompression for life-threatening swelling, and secondary prevention matched to mechanism. The alternatives “Furosemide”, “Oral prednisolone”, “Gabapentin”, “Propranolol” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/