QuestionSBA
QuestionChoice
This is incorrect as the history is highly suggestive of idiopathic intracranial hypertension, the LP would help confirm the diagnosis whilst potentially also improving symptoms. The patient should be advised on weight loss, a low-sodium diet and stopping antibiotics. They may also be given acetazolamide.
10035878
b
Discharge with simple analgesia, no investigations required
QuestionChoice
This patient had idiopathic intracranial hypertension; as classically described by signs of raised ICP (vomiting, blurry vision and severe headaches). She also has some significant risk factors for this condition (obesity and use of tetracycline antibiotics). As her CT head is normal, carrying out an LP to show raised opening pressure is the next most appropriate step.
10035877
a
Lumbar puncture
QuestionChoice
EEG is usually used in the diagnosis of epilepsy or other seizure disorders. The history here is suggestive of idiopathic intracranial hypertension (morning headaches and blurred vision) and the patient has significant risk factors for this condition (obesity and use of tetracycline antibiotics).
10035880
d
EEG
QuestionChoice
Whilst meningitis is an important differential for severe headaches, the month-long history and absence of photophobia, neck stiffness and fevers make an infective cause much less likely.
10035879
c
Commence IV ceftriaxone
QuestionChoice
This is usually used in the diagnosis of neuromuscular abnormalities such as MND, myasthenia gravis or myositis. The history here is suggestive of idiopathic intracranial hypertension (morning headaches and blurred vision) and the patient has significant risk factors for this condition (obesity and use of tetracycline antibiotics).
10035881
e
EMG
QuestionComment
are LPs not contraindicated due to the features of raised ICP?
49965
QuestionComment
think normal head imaging showing no obvious space occupying lesions means u can do LP
50172
User
subscriber
Tyrosine Kinase
User
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Contusion Kawasaki
Concept
Chapter
2693
6163
Idiopathic Intracranial Hypertension
Topic
199
Emergency Medicine
19579
A lumbar puncture is performed in cases of idiopathic intracranial hypertension (IIH) to measure the opening pressure of the cerebrospinal fluid (CSF) and to analyze the fluid for abnormalities
A 27-year-old female has a frequent severe headache, often worse on waking. She describes the pain as 9/10 and ‘pressure-like’ in nature. Since the headaches started 1 month ago, she has experienced dizziness and blurry vision. She denies any fevers, photophobia or neck stiffness. She is very concerned she has a brain tumour. She has a past medical history of type 2 diabetes, obesity and acne (for which she takes lymecycline).

She has a CT head which is reported as normal.

What is the most appropriate next step?
a