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Idiopathic intracranial hypertension — SCE Neurology MCQ

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HardHeadacheIdiopathic intracranial hypertensionSCE Neurology

A 27-year-old woman with BMI 38 has daily pulsatile headache, transient visual obscurations and horizontal diplopia. Fundoscopy shows bilateral papilloedema and examination suggests a left sixth nerve palsy. MRI brain with venography shows no mass and no venous sinus thrombosis. What is the most appropriate investigation?

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Correct answer: B — Lumbar puncture opening pressure and CSF analysis

The best answer is “Lumbar puncture opening pressure and CSF analysis”. UK stroke guidance supports urgent vascular imaging and reperfusion selection, short-course dual antiplatelet therapy for eligible minor stroke or high-risk TIA, decompression for life-threatening swelling, and secondary prevention matched to mechanism. The alternatives “Temporal artery biopsy, when the phenotype supports it”, “EEG during photic stimulation, within the relevant UK pathway”, “Serum acetylcholine receptor antibodies, after excluding important mimics”, “Non-contrast CT alone, after specialist assessment” are clinically adjacent possibilities, but they do not match the defining chronology, localisation, physiology, investigation result or UK management sequence in this stem.

Reference: National Clinical Guideline for Stroke: acute care: https://www.strokeguideline.org/chapter/acute-care/