"Malignant" Pseudotumor Cerebri

A 20-year-old lady presented to an emergency department with headache and blurred vision for 2 weeks. She was 'evaluated' and told to return on Monday. On Monday, she returned with unremitting headache, blurring, and obscurations of vision. High-grade papilledema was noted, and she was referred to a neurologist. Neuroimaging was unremarkable. CSF pressure by lumbar puncture was greater than 600 mm CSF. While being treated with repeat lumbar punctures and intravenous dexamethasone, her visual function continued to deteriorate. She was referred to a neurosurgeon for theco-peritoneal shunting. Her complaints of rapidly deteriorating vision prompted referral for optic nerve sheath decompression.