Malignant Idiopathic Intracranial Hypertension

A 24-year-old woman with a body mass index of 28 presented with 2 weeks of progressive vision loss and 2 months of headache. Visual acuity was 20/400 in both eyes, and examination showed Frisén grade 5 papilledema with extensive retinal hemorrhage and exudates (Figs A[OD = right eye] and B [OS = left eye]). Imaging did not show evidence of mass lesions or dural venous sinus thrombosis, and lumbar puncture opening pressure was 46 cm H2O with normal cerebrospinal fluid contents, consistent with idiopathic intracranial hypertension.