Papilledema in Patients with Presumed Idiopathic Intracranial Hypertension Diagnosed Without a Lumbar Puncture: A Case Report

Purpose: The purpose of this case report is to present two cases of papilledema secondary to presumed IIH and medically managed with an oral diuretic without first obtaining cerebrospinal fluid opening pressure and composition. Method: A 31-year-old female presented for evaluation of blurry vision in both eyes and a history of transient vision loss with postural changes. A 22-year-old female presented for evaluation of blurry vision in both eyes and headaches that started during her pregnancy. She reported double vision that was relieved when she closed one eye. This is a case report of two overweight females who presented with bilateral optic disc edema and were referred for neuro-ophthalmological evaluation. Both patients were treated with oral acetazolamide without lumbar puncture to confirm elevated intracranial pressure or abnormal cerebrospinal fluid components. Result: The features associated with idiopathic intracranial pressure may include papilledema, a headache, pulsatile tinnitus, blind spot enlargement on visual field testing, and diplopia. Conclusion: Although the diagnosis of IIH has historically been contingent on cerebrospinal fluid opening pressure of 25 cm H2O measured by a lumbar puncture, the health professions community should be aware that some patients are being managed with oral acetazolamide for presumed IIH-related signs and symptoms without the evidence of elevated intracranial pressure or cerebrospinal fluid abnormalities.