IIH with normal CSF pressures?
A 15-year-old girl presented with a headache, pulsatile tinnitus, and transient visual obscuration of 2 months duration. She had bilateral disc swelling with a blurred disc margin and Goldmann perimetry showed enlarged blind spots in both eyes [Figs. and ]. The lumbar CSF opening pressure was 200 mm H2O and CSF composition was normal. Brain MRI/MRV was also normal with no empty sella, globe flattening, or venous narrowing. A few days after the initial lumbar puncture, the puncture was repeated, and the rechecked CSF opening pressure was 205 mm H2O. Even though her ICP was still within the normal range, IIH was strongly suspected since she had several typical symptoms, and she told us her headache improved after the lumbar punctures. We prescribed acetazolamide 250 mg twice daily and made frequent follow-ups. Her symptoms improved after taking acetazolamide and Goldmann perimetry returned to normal []. Three months after her first visit, she had minimal swelling of both optic discs, but did not have headache or tinnitus. Currently (at 7 months after her initial visit), she is on acetazolamide 250 mg twice daily. We intend tapering the drug dosage when the disc swelling and symptoms resolve.