Abstract

This study explores a case of idiopathic intracranial hypertension and concomitant postural orthostatic tachycardia syndrome. Here we examine how two cooccurring complex ailments can affect early diagnosis, and we analyze several potential treatments. A 26-year-old, previously healthy, female with a BMI of 33 and polycystic ovary syndrome (PCOS) presented to a Florida emergency department five times over the course of six days with complaints of evolving headaches, nausea, vomiting, and blurred peripheral vision. She was admitted to the hospital after presenting to the ED for the fifth time. An ophthalmologic exam to assess for papilledema was not performed until eight days after her initial presentation, due to confounding psychologic and autonomic symptoms. After MRI proved nondiagnostic and symptoms worsened to include pulsatile tinnitus, a fundoscopic exam was performed by ophthalmology which revealed bilateral papilledema. The diagnosis of idiopathic intracranial hypertension was presumed and the patient was initially started on a taper of topiramate. However, due to persistent patient anxiety related to lack of symptom resolution, topiramate was discontinued after three days of treatment and acetazolamide was initiated instead. The patient reported symptom improvement four days after beginning treatment with acetazolamide and 19 days after discontinuing isotretinoin use.

Keywords:Idiopathic intracranial hypertension; Postural tachycardia syndrome; Pseudotumor cerebri; Ehlers-Danlos syndrome; Optic nerve sheath fenestration; Lumbar-peritoneal shunt; Ventriculoperitoneal shunt; Venous sinus stent; Quality improvement