IDIOPATHIC INTRACRANIAL HYPERTENSION WITHOUT PAPILLEDEMA: A CASE REPORT

Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is characterized by headache, papilledema, and normal cerebrospinal fluid (CSF) findings, all occurring in the absence of enlarged ventricles or an intracranial mass on computerized tomographic (CT) scan or magnetic resonance imaging (MRI). Papilledema is a cardinal feature of IIH, however, in rare cases, IIH may occur without papilledema or even with pseudopapilledema. We describe an overweight woman with long-standing headache and mild right abducent nerve paresis with a normal neurological examination including fundoscopy, Snellen visual acuity, and perimetery. After normal findings on brain MRI and laboratory tests, a lumbar puncture was performed, which was normal except for a CSF opening pressure of 400 mmH2O. However, after repeated lumbar punctures and the diagnosis of IIH, the patient’s headache gradually subsided and her diplopia improved. In obese patients with chronic headaches and cranial nerve paresis, the diagnosis of IIH should be considered, even in the absence of papilledema. A lumbar puncture is helpful both diagnostically and therapeutically.