A 27-year-old woman comes to the office due to a headache for the last 2 weeks. She describes the headache as "a dull ache" and characterizes it as intermittent, 5/10 in severity, and associated with nausea and vomiting. She is afebrile and never had such a headache before. She has no visual complaints. She is a nonsmoker and drinks alcohol only on weekends. Her only drugs are oral contraceptive pills. Her menses are regular, and she has never conceived. She has no family history of similar problems. Temperature is 37.1 C (98.8 F), blood pressure is 120/75 mm Hg, pulse is 80/min, and respirations are 15/min. She is 178 cm (5 feet 10 inches) tall, and her weight is 98 kg (216 lbs). Neurological examination is nonfocal, and there are no signs of meningeal irritation. Funduscopy reveals papilledema. MRI of the brain is normal. Which of the following complications is likely to develop if this patient is left untreated?

Question

A 27-year-old woman comes to the office due to a headache for the last 2 weeks.  She describes the headache as "a dull ache" and characterizes it as intermittent, 5/10 in severity, and associated with nausea and vomiting.  She is afebrile and never had such a headache before.  She has no visual complaints.  She is a nonsmoker and drinks alcohol only on weekends.  Her only drugs are oral contraceptive pills.  Her menses are regular, and she has never conceived.  She has no family history of similar problems.  Temperature is 37.1 C (98.8 F), blood pressure is 120/75 mm Hg, pulse is 80/min, and respirations are 15/min.  She is 178 cm (5 feet 10 inches) tall, and her weight is 98 kg (216 lbs).  Neurological examination is nonfocal, and there are no signs of meningeal irritation.  Funduscopy reveals papilledema.  MRI of the brain is normal.  Which of the following complications is likely to develop if this patient is left untreated?

Quizplus · Accepted Answer

Suspect idiopathic intracranial hypertension (pseudotumor cerebri) in a young woman with obesity who has a headache that is suggestive of a brain tumor, but with normal neuroimaging and elevated cerebrospinal fluid (CSF) pressure. Neurologic signs are usually absent, except for papilledema, visual field defects and sometimes sixth (VI) nerve palsy. There may be a history of exposure to provoking agents such as glucocorticoids or vitamin A. Oral contraceptive pills have also been associated with this disorder. The pathology involves impaired absorption of CSF by the arachnoid villi. Management includes weight reduction and acetazolamide (if weight reduction fails). When medical measures fail or visual field defects are progressive, shunting or optic nerve sheath fenestration is done to prevent blindness, which is the most significant complication of this otherwise benign disorder. (Choices A and D) Seizures and paralysis are possible complications of brain tumors. (Choice C) Intracranial bleeding is a complication of aneurysms of the brain that may present as a headache. (Choice E) Urinary incontinence is a feature of normal pressure hydrocephalus that is characterized by the triad of ataxia, urinary incontinence and dementia. Educational objective: Suspect idiopathic intracranial hypertension (pseudotumor cerebri) in a young woman with obesity who comes with a headache that is suggestive of a brain tumor, but with normal neuroimaging and elevated CSF pressure. The treatment includes weight reduction and acetazolamide. Shunting or optic nerve sheath fenestration may be performed to prevent blindness.

A 27-Year-Old Woman Comes to the Office Due to a Headache