Two Sides of the Same Coin

Idiopathic intracranial hypertension (IIH) classically presents with vision symptoms, headaches, pulsatile tinnitus, and an ophthalmic examination showing optic nerve edema. The diagnosis of IIH must exclude structural lesions and therefore neuroimaging is largely normal; although sometimes an astute appreciation of flattening of posterior globes, dilatation of optic nerve sheaths, empty sella, and/or enlarged Meckel's cave may support the diagnosis. This study reports two cases of IIH with atypical manifestations: nystagmus and chorioretinal folds and presents features for early recognition, thus allowing timely management to prevent vision loss.