darkhorse
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A 28 year old white female complains of headaches for 1 year, recently daily. They are often throbbing, usually bitemporal, and do not usually cause too much nausea, although she has vomited once or twice. She also says her vision has changed, but she went to get her glasses checked and they told her they were fine. Other pertinent history is obtained that she had a child 9 months ago, and gained 80 pounds d-uring pregnancy. She has lost 30. On physical exam she is obese. Vital signs are normal. Fundoscopic exam shows bilateral disc margin blurring with a flame hemorrage in the right. Pupils are equally reactive. Visual fields are full on finger confrontation. There is a question of mild lateral rectus weakness on the right. The rest of the cranial nerves are normal, as is her strength, sensation, and reflexes. There is no Babinski. Coordination and gait are intact.
CT of the head is normal. EEG is normal. CSF is normal except for an opening pressure of 410 mm H20.
What is the name of this syndrome? And What severe disability is she at risk for?
What would you expect to see on formal visual field testing (perimetry)?
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| neuroblastoma
Forum Guru
Topics: 99
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pseudotumor cerebri
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| drdg
Forum Senior
Topics: 31
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 pseudotumor cerebri
She is risk for blindness
Visual field testing:enlarged blind spot, followed by a nasal deficit
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| cool doctor
Forum Junior
Topics: 1
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pseudotumor cerebri
at risk for blindness
she will have peripheral visual field loss beside the papilledema.
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| darkhorse
Forum Elite
Topics: 56
Posts: 275
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Idiopathic intracranial hypertension. She is at risk for visual loss, often not noticed by the patient until it is severe, due to fovial sparing. On perimetry testing she will have an enlarged blind spot and sometimes a "nasal step" of visual loss. If acetazolamide does not decrease her intracranial pressure, surgery to open a window in the optic nerve sheath ("optic nerve sheath fenestration") is indicated to preserve her eyesight.
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