Question

Young adult gained 70 lbs in last year c/o daily severe headaches sometimes assoc with graying out of vision. Papilledema present. CT and MRI brain no abnormalities but ventricles smaller than usual. Goal of treatment in this case:

Answer 1

The goal of treatment for a young adult with severe headaches, vision changes, and papilledema is to reduce intracranial pressure, potentially due to idiopathic intracranial hypertension. Treatment may involve weight management, medication, or surgery to alleviate headaches, prevent vision loss, and reverse papilledema.

Step-by-step explanation:

The young adult in this case appears to be presenting with symptoms consistent with increased intracranial pressure (ICP), possibly due to idiopathic intracranial hypertension (IIH), or pseudotumor cerebri. Symptoms include severe headaches and transient visual changes, such as 'graying out' of vision, alongside papilledema. This condition is often associated with weight gain and in the absence of brain tumor or other detectable abnormalities on CT or MRI. The smaller-than-usual ventricles observed on imaging studies contrast with typical findings of hydrocephalus, which typically presents with enlarged ventricles due to an accumulation of cerebrospinal fluid (CSF).

The goal of treatment in this situation is to reduce the intracranial pressure. This may comprise of weight management, the prescription of medications such as acetazolamide to decrease CSF production, or in severe cases, surgical interventions like optic nerve sheath fenestration or the placement of a ventriculoperitoneal shunt. Reducing ICP can alleviate the patient's headaches, prevent any further vision loss, and reverse papilledema, thus protecting optic nerve function.