Answer: You astutely note optic disc swelling (edema), which you suspect to be papilledema in both eyes. You also note the appearance of macular (retinal) folds adjacent to the nerve caused by the edema.
You order an MRI brain and MRV, and consult neurology and ophthalmology.
When the neurology resident arrives, the patient is being wheeled back from radiology.
You pull up the MRI and MRV images and see this:
The radiology report reads:
“MRI Brain: No evidence of ischemia, hemorrhage, inflammation, or mass lesion.
MRV Head: Patent dural venous sinus system.”
The neurology team performs a lumbar puncture which reveals an opening pressure of 27 cm H20. CSF analysis shows the following: RBC 0, WBC 2, glucose 63, protein 32.
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Neuro-oph Case 2 Index
Neuro-oph Case 2: Introduction
Neuro-oph Case 2: Additional History and Physical Exam