iatroX Rounds #20
The clues
- 1
A 26-year-old woman presents to her GP with a diffuse, daily headache that has been present for the last month.
- 2
The headache is described as a pressure-like sensation that is particularly severe when she wakes up in the morning.
- 3
She describes brief episodes where her vision goes dark for a few seconds, typically triggered by standing up or leaning over.
- 4
She mentions a rhythmic, whooshing sound in her ears that matches her heartbeat, and her body mass index is recorded as 38 kg/m2.
- 5
Examination reveals bilateral papilloedema, but an urgent MRI and MR venogram of the brain show no mass, hydrocephalus or venous thrombosis.
- 6
A lumbar puncture performed in the lateral decubitus position demonstrates an opening pressure of 38 cmH2O with normal cerebrospinal fluid composition.
Idiopathic intracranial hypertension is a condition characterized by raised intracranial pressure without an identifiable cause, such as a tumour or obstruction, mostly affecting women of childbearing age with obesity.
- Daily headache worse on waking or with Valsalva manoeuvres
- Transient visual obscurations usually lasting seconds
- Bilateral papilloedema on fundoscopy
- Pulsatile tinnitus described as a rhythmic whooshing
for education and entertainment. not medical advice.