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A 17 year old college student develops severe headache and reports brief black-outs of vision in both eyes for the past 3 days. She is a slim, passionate dancer who has been practicing for a major performance. Otherwise her medical history is unremarkable. She takes no medications and has used no recreational drugs. Complete blood count and standard chemistries are normal except for a slightly elevated serum sodium. All aspects of the ophthalmic and neurologic examinations are normal except for what you see here.
What is the most likely cause of these abnormalities?
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The obvious optic fundus abnormality is bilateral florid optic disc elevation with papillary hemorrhages. The hemorrhages mark the disc elevation as acquired. The fact that these changes affect both eyes and have not damaged visual function suggests papilledema, which is acquired optic disc elevation caused by increased intracranial pressure. A process such as optic neuritis that is based within the optic nerves themselves would be expected to cause more vision damage when there is this much swelling. Idiopathic intracranial hypertension usually affects young overweight women, not slim dancers. Brain tumor is a possibility, but the history of heavy practice dancing in a college student suggests the possibility of dehydration, a promoter of dural sinus thrombosis, which is what brain imaging showed.
Treatment involves anticoagulation to prevent clot propagation and perhaps acetazolamide to reduce cerebrospinal fluid production.