IIH with normal CSF pressures?
A 52-year-old woman presented with blurred vision and headache. She said her headache started abruptly a week previously and that this co-occurred with impaired color perception and blurred vision. When she visited our office, she still complained of blurred vision, especially in her left eye, but her vision was 20/20 and color vision was normal in both eyes. Both of her optic discs were swollen and Goldmann perimetry showed enlarged blind spots bilaterally [Figs. and ]. Lumbar puncture was performed and the opening pressure was checked at 130 mm H2O; the CSF composition was normal. Brain magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) neuroimaging results were also normal; and no empty sella, globe flattening, or venous narrowing was detected by brain imaging. She was on no medication regimen, and had no other significant past medical history. We recommended another lumbar puncture, but she refused; and thus, because of the definite bilateral disc swelling and headache, which are typical features of IIH, we prescribed acetazolamide 500 mg twice daily. A week later, she told us that her headache and blurred vision had subsided, and thus, we gradually tapered the dosage during follow-up. At last visit, 4 months after the onset of her symptoms, both optic discs were normal without any swelling or temporal pallor and she no longer complained of a headache or visual symptoms. The sizes of enlarged blind spots were prominently reduced on follow-up Goldmann perimetry [].