A clinical conundrum

According to the J Pediatr Ophthalmol Strabismus 2009;46:238-240 optic disc oedema is a clinical conundrum which has potential to delay diagnosis and therefore treatment of idiopathic intracranial hypertension.

For three months a 14-year-old girl patient reported a history of headache and blurred vision. Bilateral optic disc oedema was revealed by funduscopy. Brain imaging findings were found to be normal and idiopathic intracranial hypertension was confirmed when lumbar puncture revealed elevated opening pressure of 32 cm H2O.

The computed tomography scan noted optic nerve head drusen and this was endorsed by B-scan ultrasound. Two years later symptoms were resolved with variable compliance of treatment with acetazolamide and concomitant papilledema.