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Idiopathic Intracranial Hypertension — RACP Adult Medicine MCQ

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ModerateNeurologyIdiopathic Intracranial HypertensionRACP Adult Medicine

A 30-year-old obese woman presents with worsening headache, transient visual obscurations, and pulsatile tinnitus. Fundoscopy shows bilateral papilloedema. MRI brain and MRV are normal. LP opening pressure is 32 cmH₂O. CSF composition is normal. What is the most likely diagnosis?

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Correct answer: B — Idiopathic intracranial hypertension

Headache with papilloedema, normal MRI/MRV, elevated LP opening pressure (>25 cmH₂O), and normal CSF in an obese young woman is idiopathic intracranial hypertension. Visual obscurations indicate risk to vision. Treatment: weight loss (target 5-10% body weight), acetazolamide (carbonic anhydrase inhibitor reduces CSF production), and serial LP for visual threat. Optic nerve sheath fenestration or CSF shunting for refractory cases with progressive visual loss.

Reference: Friedman 2013 IIH Criteria; eTG Neurology 2024