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'Should have gone to...': bilateral papilloedema with normal CSF pressure due to vestibular schwannoma
CT marked 300
Ronan, Geoffrey Peter
BMJ Publishing Group
A 24-year-old woman presented with bilateral blurring of her distance vision and 'dizzy spells'. She had no other neurological symptoms or medical history. She consulted an optometrist, and optical coherence tomography (OCT) was performed, which demonstrated papilloedema. She was referred to the local eye clinic for assessment and from there was referred for neurological assessment.Her initial investigations revealed no abnormalities, and brain imaging was reported to be normal. In the absence of an alternative diagnosis, idiopathic intracranial hypertension (IIH) was considered and a lumbar puncture was performed. This showed elevated protein but normal cerebrospinal fluid (CSF) pressure. MRI of the brain the next day revealed a large cerebellopontine lesion in keeping with vestibular schwannoma. She was referred to neurosurgery for operative management.This case highlights three interesting points: the aetiology of her papilloedema without raised intracranial pressure, the decision to perform a lumbar puncture in suspected IIH and community OCT as a clinical adjunct.
Bilateral papilloedema , Idiopathic intracranial hypertension , Lumbar puncture
Ronan, G. P., Gailani, G., Costello, C. and Sweeney, B. (2020) 'Should have gone to...': bilateral papilloedema with normal CSF pressure due to vestibular schwannoma', BMJ case reports, 13(12), e239406 (3pp). doi: 10.1136/bcr-2020-239406
© 2020, BMJ Publishing Group Ltd. This article has been accepted for publication in BMJ Case Reports following peer review, and the Version of Record can be accessed online at https://dx.doi.org/10.1136/10.1136/bcr-2020-239406. Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0) licence.