Peculiar case of idiopathic intracranial hypertension. Case report

Abstract

Background

Idiopathic Intracranial Hypertension (IIH) is a neurological disorder characterized by elevated intracranial pressure without any detectable intracranial mass or hydrocephalus. It typically presents in women of childbearing age and may manifest with symptoms like headache, visual disturbances, and papilledema. While the aetiology remains unknown, several systemic factors such as obesity, endocrine abnormalities, renal dysfunction, and hypertension have been associated with worsening of the clinical presentation and complexity in management.

 Case presentation

A 36-year-old female with a known history of hypertension presented with persistent headache and visual complaints. On clinical examination, her blood pressure was markedly elevated at 220/110 mmHg. Laboratory evaluation showed deranged renal function with blood urea at 85 mg/dL and serum creatinine at 4.8 mg/dL. Ophthalmic examination revealed bilateral papilledema. Neuroimaging was promptly performed to rule out intracranial mass lesions or venous thrombosis, which confirmed the diagnosis of IIH.

Multidisciplinary input from nephrology, neurology, and ophthalmology was essential to manage the complex interplay between intracranial hypertension, hypertension, and renal compromise.

 Conclusion

This case highlights an uncommon presentation of IIH in a patient with coexisting renal dysfunction and severe hypertension. While IIH is generally idiopathic, systemic factors can contribute significantly to its manifestation and prognosis. Renal dysfunction, in particular, not only complicates the use of first-line therapies like carbonic anhydrase inhibitors but also may be independently associated with altered cerebrospinal fluid dynamics and increased intracranial pressure.