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Images in Neurology
July 2013

Fulminant Idiopathic Intracranial Hypertension

Author Affiliations
  • 1Department of Neurology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
  • 2Department of Ophthalmology, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
JAMA Neurol. 2013;70(7):937-938. doi:10.1001/jamaneurol.2013.1951

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.

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