# Idiopathic Intracranial Hypertension in a Non-obese Male Patient: A Case Report

## TL;DR

A non-obese man was diagnosed with idiopathic intracranial hypertension, a condition typically seen in obese women, and showed improvement with treatment.

## Contribution

This case report expands the understanding of idiopathic intracranial hypertension by presenting an atypical male, non-obese patient.

## Key findings

- The patient exhibited classic symptoms of IIH with elevated intracranial pressure confirmed by lumbar puncture.
- Neuroimaging showed features of raised intracranial pressure without mass lesions or venous sinus thrombosis.
- Conservative treatment with acetazolamide improved symptoms and prevented visual complications.

## Abstract

Idiopathic intracranial hypertension (IIH) is a disorder characterized by elevated intracranial pressure without an identifiable structural or secondary cause and is classically seen in obese women of childbearing age. We report a case of a 34-year-old non-obese male patient who presented with a six-month history of progressively worsening daily headaches, transient visual obscurations, and intermittent pulsatile tinnitus. Neurological examination revealed bilateral papilledema with preserved visual acuity, while laboratory investigations were unremarkable. Neuroimaging with computed tomography (CT) and magnetic resonance imaging (MRI) demonstrated features suggestive of raised intracranial pressure, including partial empty sella, posterior globe flattening, perioptic subarachnoid space distension, and optic nerve tortuosity, without evidence of mass lesion or venous sinus thrombosis. Lumbar puncture confirmed an elevated opening pressure of 32 cm H₂O with normal cerebrospinal fluid composition. A diagnosis of IIH was established after exclusion of secondary causes. The patient was managed conservatively with acetazolamide and symptomatic therapy, resulting in significant improvement in headache frequency and resolution of visual disturbances over three months, with stabilization of visual fields. This case highlights that IIH can occur in atypical populations, including non-obese men, and underscores the importance of early recognition, comprehensive evaluation, and timely intervention to prevent visual morbidity.