Forgetting the fundoscope - A case of fulminant idiopathic intracranial hypertension causing rapid visual loss

Idiopathic intracranial hypertension (IIH) is a syndrome of elevated intracranial pressure without evidence of intracranial mass lesion or venous thrombosis, and bland cerebrospinal fluid examination. It mostly affects overweight women of childbearing age and if left untreated, can lead to permanent visual loss. Visual decline in this condition is generally slow, over months to years. However, a small proportion of patients develop rapidly progressive visual loss within days or weeks of onset of headaches. We describe a 29 year-old patient with fulminant IIH in whom inadequate fundoscopy and assessment of vision contributed to a delay in diagnosis and poor outcome. Unfortunately, competence with the bedside examination technique of fundoscopy is declining. We emphasise the importance of thorough assessment of vision and fundi in patients presenting with new-onset headache.