Case

A 17-year-old girl presented with a 2-week history of increasingly severe generalised headache that was worse on waking, with blurring of vision and transient visual obscurations. Her visual acuity was 6/24 right eye and 6/36 left eye with a marked constriction of visual fields. Fundus examination showed severe optic disc swelling bilaterally with a partial macular star appearance (figure 1A, B). Ophthalmic examination revealed no cause for optic disc swelling and neurological examination was otherwise normal. MRI and venography showed no space-occupying lesion, venous thrombosis or stenosis. Full blood count and renal function were normal. Cerebrospinal fluid opening pressure was 77 cm of CSF (lateral decubitus position) with normal constituents. Body mass index was 24 kg/m² (ideal range 18.5–24.9 kg/m²) and her initial history did not identify any …