skip to main content

IIH – Surgical Intervention for Vision Threat — SCE Neurology MCQ

Instant feedback + full explanation. One question, done properly.

HardHeadache & Facial PainIIH – Surgical Intervention for Vision ThreatSCE Neurology

A 28-year-old woman with IIH has papilloedema with progressive visual field loss despite maximum-dose acetazolamide and weight loss of 8 kg. Automated perimetry shows an enlarging blind spot and inferior nasal visual field defect in both eyes. What intervention should be urgently considered to preserve vision?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — Optic nerve sheath fenestration or CSF diversion procedure

In IIH with progressive visual field loss despite maximal medical therapy, surgical intervention is required to prevent permanent blindness. Options include optic nerve sheath fenestration (ONSF), which directly decompresses the optic nerve, or a CSF diversion procedure (ventriculoperitoneal or lumboperitoneal shunt). The choice depends on local expertise and whether headache or vision is the predominant problem. A: LP provides temporary relief but is not a definitive solution. C: Acetazolamide should not be pushed beyond the maximum tolerated dose. D: IV mannitol is a short-term measure, not definitive. E: Orbital decompression is for thyroid eye disease.

Reference: ABN IIH Guidelines (2018); NICE IIH Guidance