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Idiopathic intracranial hypertension — MCCQE Part 1 MCQ

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ModerateHeadacheIdiopathic intracranial hypertensionMCCQE Part 1

A 28-year-old woman with obesity has daily headache, transient visual obscurations, pulsatile tinnitus and papilloedema. Which of the following is the most appropriate next step?

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Correct answer: C — Urgent MRI with venography, then lumbar puncture if imaging is safe

Papilloedema with transient visual obscurations and pulsatile tinnitus is a vision-threatening raised-intracranial-pressure presentation. Neuroimaging must first exclude a mass lesion, and venography is required because cerebral venous sinus thrombosis can mimic idiopathic intracranial hypertension. If imaging shows no contraindication, lumbar puncture documents opening pressure and confirms normal cerebrospinal-fluid composition. Visual function also requires urgent ophthalmic assessment.

Reference: https://www.cmaj.ca/content/183/16/1881; https://www.cmaj.ca/content/idiopathic-intracranial-hypertension-need-rule-out-cerebral-venous-sinus-thrombosis