Idiopathic Intracranial Hypertension Preceding Tumefactive Multiple Sclerosis

TL;DR

A young woman developed idiopathic intracranial hypertension and tumefactive multiple sclerosis simultaneously, highlighting the importance of accurate diagnosis in overlapping neurological conditions.

Contribution

This case report highlights the rare concurrence of IIH and tumefactive MS, emphasizing diagnostic challenges and clinical management.

Findings

A young female presented with IIH symptoms and later developed tumefactive MS.

Steroid treatment led to marked improvement, supporting the MS diagnosis.

Accurate diagnosis required thorough imaging and clinical evaluation.

Abstract

Idiopathic intracranial hypertension (IIH) and multiple sclerosis (MS) are rare neurological disorders that largely affect females within the reproductive age group. The clinical pictures of both diseases can overlap, which therefore places great importance on accurately studying and reporting their concurrence. Therein, we report a case of IIH presenting and progressing simultaneously with MS. This young, previously healthy female presented with the primary complaint of a severe right-sided headache associated with blurred vision and a finding of papilledema. The initial investigations including a lumbar puncture (LP) that revealed high opening pressure (more than 25 mm H2O) with normal cerebrospinal fluid (CSF) analysis led to an impression of idiopathic intracranial hypertension, and she was treated accordingly with acetazolamide and scheduled for regular follow-ups with both neurology and neuro-ophthalmology. However, about two months after the initial presentation, she complained of unusual headaches, and a neuro-ophthalmology clinical evaluation revealed complete right homonymous hemianopia, suggesting a lesion in the left temporo-parietal occipital region. The patient was thus admitted as a case of cerebral edema following an urgent brain magnetic resonance imaging (MRI). After obtaining thorough imaging and workup, the patient was given steroids and markedly improved, favoring a diagnosis of tumefactive MS with IIH.

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