Gordon SK Yau, Jacky WY Lee, Theo TK Chan and Can YF Yuen
The typical presenting ocular signs of idiopathic intracranial hypertension (IIH) include bilateral papilledema, enlarged blind spots, and abducens nerve palsy. Unilateral papilledema with choroid folds is an atypical presenting sign of IIH. The authors report the case of a 55-year-old Chinese gentleman, of medium-built, presenting with right eye transient visual obscuration associated with tinnitus for 2 weeks. Physical examination revealed ipsilateral choroidal folds and disc swelling. Computerized tomography of the brain and orbit with contrast revealed no intracranial space occupying lesions. Lumber puncture revealed an elevated opening cerebrospinal fluid pressure (30 cmHâO) with normal biochemistry. Subsequent contrast Magnetic Resonance Imaging of the brain and orbit with venogram revealed features of empty sella, compatible with the diagnosis of IIH. He was subsequently treated with oral acetazolamide for 6 months and the symptoms resolved. Unilateral papilloedema with choroidal folds is an uncommon presentation of IIH, a lumbar puncture with opening pressure measurement and proper neuro-imaging should be considered when there is suspicion of IIH