This 13YO girl presented with headaches and tinnitus with 20/25 vision OU. There was moderate bilateral optic nerve swelling, beautifully imaged with Triton swept-source OCT. Visual fields showed enlarged blind spots.
MRI scanning was normal, and her lumbar puncture had a severely elevated opening pressure of 49mm H2O, establishing the diagnosis of idiopathic intracranial hypertension (IIH).
After six weeks of oral Diamox, her headaches and tinnitus had improved significantly, and the optic nerve edema had virtually resolved bilaterally.
Learning Points:
Remember that papilledema is not synonymous with optic nerve swelling. Papilledema is defined as bilateral optic nerve swelling due to elevated intracranial pressure.
