Neurology Case Challenge: A 19-Year-Old With Tinnitus, Vision Problems, and Headaches

Sumaira Nabi, MBBS; Muhammad Fateen Rashid, MBBS; Shahzad Ahmed, MBBS

Disclosures

May 31, 2022

Management goals for IIH include significant control of headache and preservation of visual acuity. Management of IIH includes conservative management, medical management, and surgical management.

Conservative management includes weight loss and low salt intake. Studies have demonstrated significant improvement in symptoms after weight loss.[16] Medical management includes drugs that lower CSF pressure/production and prophylactic pain management. Drugs used for lowering CSF pressure include carbonic anhydrase inhibitors like acetazolamide, loop diuretics like furosemide, topiramate, indomethacin, and iron. Valproic acid and tricyclic antidepressants are used for prophylaxis against headache.[17] Surgical management includes serial lumbar punctures, CSF shunting (lumboperitoneal shunt, ventriculoperitoneal shunt), optic nerve sheath fenestration, cerebral venous stenting, and bariatric surgery for weight control.[18]

IIH is usually a slowly progressive disease. Early diagnosis and management leads to partial recovery or slows down the worsening of symptoms. Fulminant disease carries a poor prognosis and requires urgent surgical intervention, mostly of no significant benefit.[19]

This patient was prescribed 500 mg of acetazolamide (twice daily) along with analgesics. She was then referred to an ophthalmologist and neurosurgeon for optic nerve sheath fenestration.

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