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Idiopathic intracranial hypertension — SCE Neurology MCQ

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ModerateHeadacheIdiopathic intracranial hypertensionSCE Neurology

A 31-year-old man presented with progressive daily headache, transient visual obscurations and pulsatile tinnitus. On examination, there was bilateral papilloedema and sixth nerve palsy. Initial investigations showed: MRI venography excluded venous sinus thrombosis; LP opening pressure was 36 cm CSF. What is the most likely diagnosis?

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Correct answer: D — Idiopathic intracranial hypertension

Idiopathic intracranial hypertension is the best answer because the vignette describes Idiopathic intracranial hypertension: raised opening pressure with papilloedema and normal imaging suggests IIH. Migraine with aura is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Reversible cerebral vasoconstriction syndrome and Cluster headache are less appropriate because they would require different localisation, timing or test findings; Giant cell arteritis would fit a different syndrome. Clinical pearl: migraine does not cause papilloedema or raised CSF pressure.

Reference: UK consensus guidelines on management of idiopathic intracranial hypertension: https://pmc.ncbi.nlm.nih.gov/articles/PMC6166610/