Welcome to question of the day #45

Eyetools question of the day #45 

A moderately obese 32-year-old female with systemic hypertension self-referred with the following symptoms:

  • Bad headaches for the last week, described as pain in the back of her head and neck, with pressure localised around the left eye when she stood up.
  • Horizontal diplopia at all distances for the last 24 hours.
  • Loss of peripheral vision.
  • Periods of tunnel vision.
  • Her GP had prescribed anti-migraine medication.
  • Pupil function was normal, ocular-motility indicated an underacting left lateral rectus with a 20 prism dioptre left esotropia, with bilateral enlarged blind spots and an inferonasal arcuate visual field defect in each eye and raised optic nerve heads.

The patient had vague visual complaints, headaches, a left 6th cranial nerve palsy, bilateral visual field defects and papilloedema. Her signs and symptoms were due to pseudotumour cerebri. She was referred as an emergency case to a neurologist and was prescribed medication to reduce the production of cerebral spinal fluid which reduced her intracranial pressure. The subjective symptoms, 6th nerve palsy and papilloedema resolved within five weeks of treatment.

Pseudotumour cerebri, sometimes referred to as idiopathic intracranial hypertension, is a disorder highlighted by an elevated intracranial pressure without an accompanying space-occupying lesion or evidence of ventriculomegaly-enlargement of the ventricles of the brain.