Question

A 19 year old female comes to her physician because of visual blurring for the past week. For the past few months, she has also has experienced daily headaches, which are worst in the morning upon awakening and improve throughout the day or after taking ibuprofen. Her past medical history is unremarkable, and her only medication is a combination oral contraceptive pill. Physical examination shows height 62 inches (157 cm), weight 206 lbs. (93 kg), temperature 37.2 C (99.0 F), pulse 72, blood pressure 118/76. Fundoscopic examination shows bilateral papilledema. Neurological examination shows no focal deficits. CT shows normal ventricles and no evidence for mass lesion, but increased volume and distension of the perioptic subarachnoid space. Lumbar puncture shows an elevated opening pressure and clear CSF with normal cell counts, protein, and glucose. Which of the following is the most likely diagnosis in this patient?

A. Aseptic meningitis
B. Craniopharyngioma
C. Dandy-Walker malformation
D. Subdural hemorrhage
E. Pseudotumor cerebri

Answer 1

The likely diagnosis for the patient is Pseudotumor cerebri, indicated by symptoms of increased intracranial pressure, normal imaging results, and elevated lumbar puncture opening pressure.

Step-by-step explanation:

The most likely diagnosis for the 19-year-old female presenting with visual blurring, headaches worsening in the morning, and bilateral papilledema on fundoscopic examination, is Pseudotumor cerebri (also known as Idiopathic Intracranial Hypertension).

This condition is characterized by increased intracranial pressure without any detectable intracranial pathology on imaging studies such as CT or MRI, as seen in this patient. The elevated opening pressure on lumbar puncture without abnormalities in cell counts, protein, or glucose further supports this diagnosis. Pseudotumor cerebri commonly affects young, obese females and can be exacerbated by the use of oral contraceptives.