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Case (76)

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Dr.Adnan:

20 years old female patient presented with projectile vomiting and morning headache of 3 weeks duration, the patient is overweight and was using anti-acne medications excessively. on examination the patient is found to have papilledema.

1-What is the next investigation you would do?
2-If it came back negative , What is the most likely diagnosis?
3-What is the most worrisome sequale/complication?
4-How would you manage this patient?

Irwan:


1.  visual field testing.  MRI brain and MR venography and lumbar punctures with CSF opening pressures measured and a CSF sample sent for analysis.

2. pseudotumor cerebri/iih

3. visual loss

4. medication :acetazolamide, surgery :NII sheath decompression, shunting

Dr.Adnan:
Correct Irwan,,,Except

1- CT-scan,,,Since There is papilledema and history is suggestive of increased ICP you don't want to rush lumber puncture, Rule out any mass lesions (e.g a tumor) ,,, Visual field testing is done once you rule out more serious conditions and made the dx of Pseudomotor cerebri.

2-Correct,,Text book case of Pseudomotor cerebri (young Obese female with hypervitaminosis A -- tx For acne)
3-Correct,,,, Visual loss due to chronic papilledema
4-Correct,,,There is no specific management for pseudo-motor cerebri, the aim is to decrease ICP...  

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