A 25-year-old woman presents with progressively worsening headache, transient visual obscurations, and horizontal double vision. She is obese with a BMI of 38. Fundoscopy shows bilateral disc oedema. MRI brain and MR venography are normal. Lumbar puncture reveals an opening pressure of 38 cm CSF. The most appropriate initial management is:

• A High-dose IV corticosteroids
• B Emergency ventriculoperitoneal shunt
• C Oral acetazolamide and weight reduction ✓
• D Bilateral optic nerve sheath decompression

Explanation

This presentation describes idiopathic intracranial hypertension (IIH, formerly pseudotumour cerebri), characterised by raised intracranial pressure, papilloedema, visual obscurations, and headache in the absence of any intracranial pathology on imaging. It predominantly affects obese young women. First-line management is weight reduction (most effective long-term) and oral acetazolamide (carbonic anhydrase inhibitor that reduces CSF production). Optic nerve sheath fenestration or CSF diversion shunts are reserved for vision-threatening cases.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.