Optic disc edema in a pickwickian man mimicking hypertensive crisis

A 31-year-old obese man with essential hypertension developed progressive optic disc edema despite mild-to-moderate elevations of his blood pressure. Neurologic evaluation, including cranial axial tomography, nuclear magnetic resonance scan, and lumbar puncture, was unremarkable. Further evaluation revealed that the patient had sleep apnea syndrome. In contrast to the few patients reported with this syndrome, he had normal cerebrospinal fluid pressures and hypertension. The possible interplay of sleep apnea and hypertension in the development of optic disc edema is considered.