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Fulminant idiopathic intracranial hypertension is extremely rare but invariably is associated with permanent blindness unless there is prompt intervention. Hypothetically, a rapid increase in pressure in the perineural space around the optic nerve can lead to ischemic optic neuropathy and blindness.1 An 18-year-old overweight woman with rapidly progressive visual loss over 4 days (leading to no light perception), nonreactive pupils, binocular abduction deficit suggestive of sixth nerve palsies, bilateral optic-disc edema (Frisén stage 5),2 and cerebrospinal fluid opening pressure at 600 mm H2O received a diagnosis of fulminant idiopathic intracranial hypertension.1 The results of cerebrospinal fluid laboratory studies, magnetic resonance imaging of the brain, and vascular imaging were normal. Our Figure, A and B, shows magnetic resonance imaging scans of the patient’s orbits at the time of presentation.
Shaikh AG, Bates JH, Yeates SW, Katirji B, Devereaux MW. Fulminant Idiopathic Intracranial Hypertension. JAMA Neurol. 2013;70(7):937-938. doi:10.1001/jamaneurol.2013.1951