It is Not Just a Headache: Atypical Case Presentation of Idiopathic Intracranial Hypertension

Abstract

Idiopathic intracranial hypertension (IIH) is an uncommon but serious neurological condition that can present with various symptoms. In this report, we present a case of IIH that initially presented with left-sided ptosis and an inferior altitudinal visual field defect, along with a review of the relevant literature. A 64-year-old Egyptian man presented with a 1-week history of acute onset of left eye ptosis and a transient episode of complete visual loss in the same eye, lasting a few seconds. Vision recovered spontaneously, however, there was persistent blurring along with an inferior altitudinal visual field defect. Brain MRI showed bilateral frontal and parietal subcortical ischemic foci, lacunar infarcts, and subcortical arteriosclerotic encephalopathy. A computed tomographic angiography was performed to assess the cerebral arteries. Stenosis of both transverse sinuses was accidentally discovered in the venous phase of CTA. A high opening pressure was found. Diagnostic central venous catheterization showed bilateral transverse sinus stenosis; transverse sinus stenting was recommended. The patient had a left transverse sinus stent inserted. He was given a diagnosis of IIH. IIH can be atypically presented and occur later in life. Patients with normal body mass index and those 50 years or older make up a small proportion of patients with IIH but appear to have better visual outcomes than more typical patients with IIH. This case underscores the importance of considering IIH diagnosis in patients with unexplained visual or ocular presentations.