Idiopathic Intracranial Hypertension: an Unusual Presentation of Neuromyelitis Optica—A Case Report

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system (CNS) known for its predilection for the spinal cord, the optic nerves, and the brainstem. However, headache and more specifically idiopathic intracranial hypertension (IIH) is an unusual presentation of the disease. Here, we present a 40-year-old female, who initially presented in our department of neurology with refractory headache, blurry vision, and diplopia. She had an undiagnosed episode of headache, blurred vision, scotomas, and decreased visual acuity in her right eye, 6 months earlier. The actual ophthalmologic assessment revealed a decreased visual acuity in both eyes, optic atrophy in the right eye, and papilledema in the left one. The lumbar puncture showed a raised opening pressure of 30 cm H2O. Venous brain MR, cerebrospinal fluid examination, and other laboratory investigations were normal. Optic neuritis was discovered on visual evoked potential. The patient was treated with intravenous steroids and acetazolamide with a good outcome. One year later, she appeared with longitudinally extensive myelitis. The patient tested positive for anti-NMO antibodies which finally led to the diagnosis of NMOSD. Through this case, we highlight the importance of suspecting optic neuritis in patients having a headache and visual impairment and we suggest performing an exhaustive ophthalmologic examination to investigate effectively the eyes and the optic nerves.