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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—including formal visual field examination—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 affected both eyes and did not damage visual function suggests papilledema, defined as acquired optic disc elevation
caused by increased intracranial pressure.
What about the other answer choices here? Optic neuritis would cause more vision damage when there is this much swelling. Idiopathic intracranial hypertension usually affects young overweight women, not slim dancers. Brain tumor would certainly be a cause of papilledema, 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.
Diagnosis depends on requesting appropriate imaging (contrast CT or MR venography, as shown here) and expert interpretation!
Treatment involved anticoagulation to prevent clot propagation and acetazolamide to reduce cerebrospinal fluid production. She recovered without lingering visual deficits.
What about the other answer choices here? Optic neuritis would cause more vision damage when there is this much swelling. Idiopathic intracranial hypertension usually affects young overweight women, not slim dancers. Brain tumor would certainly be a cause of papilledema, 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 involved anticoagulation to prevent clot propagation and acetazolamide to reduce cerebrospinal fluid production. She recovered without lingering visual deficits.