Headaches, idiopathic intracranial hypertension, and pseudopapilledema

A young woman with frontal headaches of several months' evolution and monocular transient "tunnel" obscurations that developed after a generalized seizure is described. She had elevation of the optic discs (pseudopapilledema), greater on the side of her visual symptoms. No intracranial lesions were identified. Cerebrospinal fluid pressure was increased, diagnostic of idiopathic intracranial hypertension (IIH). Because both IIH and pseudopapilledema may cause transient visual obscurations (TVO), fortuitous discovery of pseudopapilledema in a patient with TVO does not preclude the necessity of performing a diagnostic lumbar puncture. Establishing the correct diagnosis has obvious therapeutic and prognostic implications.