Disk edema in an overweight woman

A 46-year-old extremely obese black woman presented with headaches, blurred vision, and visual obscurations. Her exam was notable for bilateral severe papilledema, retinal hemorrhages, and lethargy, Her CAT scan was normal, and a spinal tap revealed a very high opening pressure. Although this patien...

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Bibliographic Details
Published in:Survey of ophthalmology 1995, Vol.39 (4), p.307-314
Main Authors: Wolin, Mitchell J., Brannon, William L.
Format: Article
Language:English
Subjects:
Female
Humans
idiopathic intracranial hypertension
Middle Aged
Obesity Hypoventilation Syndrome - complications
Obesity Hypoventilation Syndrome - diagnosis
obstructive sleep apnea
papilledema
Papilledema - diagnosis
Pickwickian syndrome
pseudotumor cerebri
Pseudotumor Cerebri - diagnosis
Pseudotumor Cerebri - etiology
Roth spots
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Summary:A 46-year-old extremely obese black woman presented with headaches, blurred vision, and visual obscurations. Her exam was notable for bilateral severe papilledema, retinal hemorrhages, and lethargy, Her CAT scan was normal, and a spinal tap revealed a very high opening pressure. Although this patient's presentation mimicked pseudotumor cerebri, the lethargy and retinal hemorrhages were atypical. Her hospital evaluation was notable for elevation of the serum bicarbonate level, and she was subsequently found to have hypoxia and hypercapnia on a blood gas. The patient was diagnosed as Pickwickian syndrome, with obstructive sleep apnea. Treatment of the pulmonary problem resulted in dramatic improvement in her eye findings and her lethargy, and optic nerve sheath fenestration was not necessary
ISSN:0039-6257
1879-3304
DOI:10.1016/S0039-6257(05)80108-0