Raised intracranial pressure in patients with headache

摘要

A 24 year old woman attended the emergency department with increasing headaches and visual disturbances, and was admitted to hospital for investigation. Computed tomography scans of the head and a computed tomography venogram taken on day 3 were normal. On day 7, she underwent lumbar puncture and her cerebrospinal fluid opening pressure was 70 cm CSF. On day 8, she was examined with an ophthalmoscope and found to have papilloedema. Her best corrected visual acuity was reduced at 6/24 bilaterally and she had bilateral peripheral visual field loss to confrontation. She received a diagnosis of fulminant idiopathic intracranial hypertension and underwent an emergency lumbar peritoneal shunt. Within two weeks, her vision improved to 6/9 bilaterally. Speaking about her experience, she says, "I can't imagine what it would have been like to have been blind" (see video, bmj.com).