Fulminant idiopathic intracranial hypertension presenting as sudden bilateral vision loss

Fulminant idiopathic intracranial hypertension (IIH) is an uncommon, rapidly progressive form of IIH characterised by an acute decline in vision over days to weeks. It is a neuro-ophthalmic emergency in which immediate effective treatment is imperative to prevent irreversible optic nerve injury and permanent vision loss. We report a case of a woman who presented with a sudden onset of recurrent headaches and progressively worsening diminution of vision in both eyes. She was diagnosed with IIH. Despite intensive medical management and therapeutic lumbar puncture, her vision deteriorated significantly in both eyes over a few hours. Neuroimaging and venography showed dural venous sinus stenosis with a significant pressure gradient. She underwent an urgent venous sinus stent placement procedure, while optic nerve sheath surgery was reserved as a secondary option. Within 24 hours, she symptomatically improved, and her vision recovered dramatically to 6/6 in both eyes.