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Case report
Seizure as the presenting sign of idiopathic intracranial hypertension
  1. Aman Pal Sayal1,
  2. Manav Vyas2 and
  3. Jonathan A Micieli2,3
  1. 1Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Jonathan A Micieli; jonathanmicieli{at}gmail.com

Abstract

A 38-year-old man presented to the emergency room with a new generalised tonic-clonic seizure. He also complained of headaches, and brain MRI/magnetic resonance venography (MRV) showed an anterior left temporal encephalocoele with gliosis and brain parenchyma herniating into the left foramen ovale. Ophthalmic examination revealed bilateral optic disc oedema and his lumbar puncture confirmed an elevated opening pressure of 48 cm of water. He was diagnosed with idiopathic intracranial hypertension (IIH) and his papilloedema resolved with weight loss and acetazolamide. Raised intracranial pressure (ICP) can be associated with encephalocoeles and lead to seizures. It is important to screen for papilloedema in these patients as they are at risk for permanent vision loss. This was a unique case in which IIH was diagnosed only after a seizure due to an encephalocoele, which was likely related to chronically undetected raised ICP.

  • neuro-opthalmology
  • ophthalmology

https://doi.org/10.1136/bcr-2021-246604

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    Footnotes

    • Contributors APS: Writing of case-report. MV: Significant revisions and additions to case-report. JM: Writing of case-report and significant revisions.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.