A 31-year-old woman comes to the office due to transient visual changes that are characterized by "loss of vision for a minute" and commonly precipitated by bending forward or lifting objects. During the last 3 months, she has had persistent headaches that she attributes to migraines. The patient takes over-the-counter analgesics as needed. Blood pressure is 140/90 mm Hg and pulse is 72/min and regular. BMI is 32.4 kg/m². Funduscopic findings of the left eye are shown in the image below, with similar findings in the right eye. Which of the following is the most likely cause of the observed funduscopic findings in this patient?

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11ec160b_3b14_c1d7_9249_f34476ca531f_MD0001_00 This patient's clinical presentation is consistent with idiopathic intracranial hypertension (pseudotumor cerebri). This condition typically presents in young obese women with daily headache, bilaterally symmetric papilledema, and transient visual disturbances related to impaired cerebral venous outflow and elevated intracranial pressure. Symptoms characteristically worsen during the Valsalva maneuver (eg, bending down, coughing) because intracranial pressure increases. Increased intracranial pressure is transmitted through the cerebrospinal fluid in the subarachnoid space, which is continuous with the optic nerve sheath. This buildup of pressure compresses the optic nerves externally, which in turn impairs axoplasmic flow within the optic nerves, causing bilateral optic disc edema (papilledema). Funduscopy shows elevation of the optic disc with blurred disc margins. (Choice A) Choroidal inflammation is characteristic of posterior uveitis, which typically presents with painless vision loss and floaters. Ophthalmic examination may show inflammation/leukocytes in the vitreous humor. Uveitis is often associated with systemic inflammatory disorders (eg, inflammatory bowel disease, ankylosing spondylitis). (Choice C) An acute increase in intraocular pressure is characteristic of angle-closure glaucoma, which typically presents with painful monocular vision loss, headache, vomiting, and conjunctival injection with a poorly reactive middilated pupil. Chronic increases in intraocular pressure can cause optic disc cupping due to atrophy of the optic nerve head. Glaucoma usually affects older individuals. (Choice D) Optic neuritis is frequently associated with multiple sclerosis, a demyelinating CNS disease that typically affects women age 15-50. Although swelling of the optic disc can be present on funduscopy, optic neuritis usually causes sustained monocular vision loss over several weeks with painful eye movement rather than daily headaches with transient bilateral vision loss. (Choice E) Retinal ischemia can manifest with painless transient monocular vision loss (amaurosis fugax) and is most commonly caused by atherosclerotic emboli originating from the ipsilateral carotid artery. Funduscopy may show embolic plaques and retinal whitening caused by ischemia. This condition typically affects older patients with vascular risk factors (eg, hypertension, hyperlipidemia, diabetes mellitus). Educational objective: Idiopathic intracranial hypertension (pseudotumor cerebri) presents in young obese women with daily headache (which worsens during the Valsalva maneuver), bilaterally symmetric papilledema, and transient visual disturbances. Increased intracranial pressure compresses the optic nerves, resulting in impaired axoplasmic flow and optic disc edema. __________ References: Pathogenesis of optic disc edema in raised intracranial pressure. (http://www.ncbi.nlm.nih.gov/pubmed/26453995) Pseudotumor cerebri: brief review of clinical syndrome and imaging findings. (http://www.ncbi.nlm.nih.gov/pubmed/21680652)

A 31-Year-Old Woman Comes to the Office Due to Transient