This patient has bilateral papilloedema, giving the history of headache and vomiting, the most likely cause is increased in ICP secondary to SOL.
Other differentials that needed to be considered are:
- Raised intracranial pressure d/t space occupying lesions, meiningitis, subarachnoid haemorrhage, benign intracranial hypertension.
- Cerebral oedema following head injury or cerebral anoxia
- Metabolic causes such as carbon dioxide retention, steroid withdrawal, thyroid eye disease, vitamin A intoxication, lead poisoning
- Haematological and circulatory disorders eg central retinal vein thrombosis, superior vena cava obstruction, polycythaemia rubra vera, multiple myeloma, macroglobulinaemia
From history
- Headache
- Transient visual disturbances
- Diplopia (due to associated 6th nerve palsy)
- History of hypertension, brain tumour
- History of ingestion of steroid, hypervitaminosis A (a cause of benign intracranial hypertension)
Physical examination – 1st manifestation of papilloedema is engorgement of veins, field defect – enlargement of blind spot.
Investigations
- CT scan of brain
- CSF analysis depending on CT scan findings
In a young female with blurring of vision and headache, benign intracranial hypertension need to be considered.
Features to suggest BIH – pt alert, no localizing neurological signs except 6th nerve palsy, opening pressure of CSF > 20 cmH2O, normal ventricles and normal study in CT and MRI
Treatment of BIH – discontinuation of steroids, weight loss, drugs such as carbonic anhydrase inhibitor, diuretics, serial lumbar puncture, lumboperitoneal shunt, optic nerve fenestration, subtemporal decompression.
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