By Dmitry Pyatetsky, MD, and David Gu, MD
A 44-year-old woman 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 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. She ultimately underwent suboccipital craniotomy and tumor resection which resulted in normalization of her intracranial pressure and resolution of her headaches and papilledema.
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.
Dmitry Pyatetsky, MD is an associate professor of Ophthalmology and Medical Education at Northwestern Medicine.
David Gu, MD, Ophthalmology resident at Northwestern Medicine.
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