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Idiopathic Intracranial Hypertension — RACP Adult Medicine MCQ

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EasyNeurologyIdiopathic Intracranial HypertensionRACP Adult Medicine

A 38-year-old woman presents with a 6-week history of headache worse in the mornings, associated with transient visual obscurations and pulsatile tinnitus. She has a BMI of 38. Fundoscopy shows bilateral papilloedema. CT brain and MRV are normal. LP opening pressure is 32 cmH₂O. What is the diagnosis?

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Correct answer: C — Idiopathic intracranial hypertension

Idiopathic intracranial hypertension (IIH) presents with headache, papilloedema, visual obscurations, and pulsatile tinnitus in overweight women of childbearing age. Diagnostic criteria require elevated LP opening pressure (>25 cmH₂O), normal neuroimaging, and normal CSF composition. Management includes weight loss (the only disease-modifying therapy), acetazolamide, and serial visual field monitoring. CSF diversion (shunt) or optic nerve sheath fenestration for refractory visual loss.

Reference: eTG – 2025 – Neurology; Friedman et al – 2013 – IIH Diagnostic Criteria