Bilateral Optic Disc Edema in the Course of Idiopathic Intracranial Hypertension: A Case Report

Idiopathic intracranial hypertension (IIH) is a rare disease characterized by elevated cerebrospinal fluid pressure in the absence of structural changes in the brain. One of the main symptoms of IIH is deterioration of visual acuity with evidence of swelling of the optic nerve disc. Other complaints reported by patients may also include headaches, dizziness, and tinnitus. A 46-year-old female patient presented to the ophthalmology outpatient clinic because of bilateral visual acuity deterioration. The patient had previously been treated for hypertension and dizziness, and she also reported increasing obesity over the past three months. A fundus examination revealed bilateral swelling of the optic disc with obliterated borders and elevation above the fundus level. An optical coherence tomography study was also performed. The patient was consulted neurologically. A CT scan and an MRI of the head were performed, showing no abnormalities. The collected cerebrospinal fluid showed an elevated pressure value. Based on the clinical picture, IIH was diagnosed. Acetazolamide (2 x 250 mg) was included in the treatment, with an improvement in visual acuity after one month of treatment. In addition, the patient was referred to the metabolic disease clinic for weight reduction. The presented case is intended to highlight the need to consider IIH in patients with bilateral visual deterioration and optic disc edema. Early diagnosis and implementation of pharmacological treatment, as well as lifestyle modification with weight reduction, can prevent permanent complications in the form of permanent optic nerve damage, among others.