The New England Journal of MedicineImages in Clinical Medicine: Idiopathic Intracranial Hypertension

Unraveling the Obesity-Pressure Nexus in Neurological Health

In a striking case of idiopathic intracranial hypertension (IIH), a 25-year-old woman with severe obesity presented with classic symptoms indicative of elevated intracranial pressure. This case not only underscores the critical connection between obesity and IIH but also highlights the importance of timely diagnosis and intervention in such neurological disorders. The findings from this case offer valuable insights into the management and prognosis of IIH, emphasizing the role of weight management and medication in alleviating symptoms.

Key Points

• Patient Profile: A 25-year-old severely obese woman with a BMI of 57.
• Symptoms: Blurred vision, transient visual obscurations, daily headaches, and intermittent whooshing sounds.
• Neurological Findings: Optic-disk swelling and retinal hemorrhages in both eyes; normal visual-field and cranial-nerve testing results.
• Imaging Results: MRI and venography showed flattened posterior globes, elevated optic-nerve heads, an empty sella, and transverse sinus stenoses without obstruction.
• Lumbar Puncture: Elevated opening pressure at 55 cm of water (normal: 10-20 cm); normal cerebrospinal fluid analysis.
• Diagnosis: Idiopathic Intracranial Hypertension (IIH).
• Treatment and Counseling: High-dose acetazolamide and weight loss counseling.
• Follow-up Outcome: Decreased papilledema and continued treatment after 1 month.

According to the National Institutes of Health, the prevalence of idiopathic intracranial hypertension is increasing, particularly among women of childbearing age. It correlates strongly with rising obesity rates, a major risk factor for IIH.

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