A 48-year-old obese woman presents with chronic daily headache, transient visual obscurations, and pulsatile tinnitus. Fundoscopy shows bilateral papilledema. MRI brain is normal with empty sella. MR venography is normal. CSF opening pressure is 320 mmH2O with normal composition. Which medication is the first-line treatment?
- A Prednisolone
- B Acetazolamide ✓
- C Furosemide
- D Topiramate
Correct answer: B. Acetazolamide
Explanation
Idiopathic intracranial hypertension (IIH) presents with headache, papilledema, and pulsatile tinnitus in obese women of childbearing age, with normal neuroimaging and elevated CSF opening pressure. Acetazolamide is first-line therapy, reducing CSF production. Topiramate is an alternative. Weight loss is essential. Steroids and furosemide are not standard first-line agents.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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