An unusual presentation of pseudotumor cerebri

A 25-year old grossly obese woman presented with decreased visual acuity. She had bilateral total (internal and external) ophthalmoplegia, a left-sided seventh cranial nerve palsy, and florid bilateral papilledema. The diagnosis of pseudotumor cerebri was made on the basis of high cerebrospinal fluid pressure and the absence of other abnormalities on systemic, neurologic, and neuroradiologic examination. The patient responded favorably to corticosteroid treatment; however, bilateral optic atrophy occurred with persistent loss of visual field and acuity.