CASE REPORT: BILATERAL DISC EDEMA IN AN OVERWEIGHT FEMALE PATIENT

By Dmitry Pyatetsky, MD

A 44-year-old female patient with a BMI of 36 and 5-pound weight gain in the past year presented to Northwestern Medicine Ophthalmology with a three-year history of headaches and a month-long history of transient visual obscurations described as a “white out” and shadows in her vision lasting 30 seconds at a time.

Her examination revealed best-corrected visual acuity of 20/20 in both eyes without color vision deficit or afferent pupillary defect. The intraocular pressure was normal and anterior slit-lamp exam was unremarkable. A dilated funduscopic exam revealed bilateral optic disc edema, mild blurring of peripapillary vessels and a peripapillary hemorrhage, raising the concern for elevated intracranial hypertension.

She was urgently sent to the emergency department for an MRI of her brain and orbits which revealed a 3-centimeter dural-based lesion of the left posterior fossa occluding her left sigmoid sinus, which was overall concerning for a meningioma. She was hospitalized and started on IV corticosteroids, with plans to undergo suboccipital craniotomy and tumor resection.

While a female who is overweight and experiencing headaches and bilateral disc edema may have idiopathic intracranial hypertension (IIH), prompt neuroimaging should always be obtained as IIH is a diagnosis of exclusion. Other etiologies of papilledema, such as an intracranial tumor or venous thrombosis must be ruled out first.