Resolution of Fulminant Idiopathic Intracranial Hypertension Treated with Acetazolamide

Idiopathic intracranial hypertension (IIH) is a condition of elevated intracranial pressure commonly seen in obese women of childbearing age. Fulminant IIH is a rare subset of IIH that is characterized by rapidly progressive vision loss in less than 4 weeks, and typically requires surgical intervention for treatment. We describe a 36-year-old man with a 3-week history of acute onset vision loss and fulminant IIH in whom severe bilateral hemorrhagic optic disk edema was identified. There were also associated moderate visual field defects. Given the rapid onset of symptoms and severity of papilledema, surgical management was discussed but the patient had opted for medical management and close follow-up. He began oral acetazolamide, which was escalated to the maximal dose of 4 g and seen regularly with close follow-up. Four months after presentation, he was completely symptom free and the bilateral optic disk edema had resolved. His visual fields had also improved. We emphasize the importance of close follow-up in fulminant IIH and highlight that although most cases often require surgical intervention, some patients may show improvement with medical management only.