SHM Converge Scientific Abstract ePoster Gallery-Fulminant Idiopathic Intracranial Hypertension and New Heart Failure: A Coincidence?

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This case describes a 34-year-old man with morbid obesity and recurrent headaches who presented with 2 months of rapidly worsening bilateral vision loss, weight gain, lower-extremity and scrotal edema, and shortness of breath. Ophthalmologic exam showed severe bilateral papilledema, and further evaluation revealed pitting edema and evidence of volume overload.<br /><br />Workup demonstrated brain natriuretic peptide elevation, vascular congestion on chest X-ray, and echocardiographic evidence of heart failure with preserved ejection fraction plus biventricular failure and reduced right ventricular function. CT head showed findings suggestive of idiopathic intracranial hypertension (IIH), and lumbar puncture confirmed markedly elevated opening pressure of 60 cm H2O. He was admitted to the ICU with acute hypoxic and hypercapnic respiratory failure due to heart failure, requiring aggressive diuresis and non-invasive ventilation.<br /><br />The patient was treated with acetazolamide, prolonged diuresis to optimize his volume status, and ultimately ventriculoperitoneal shunt placement because of fulminant IIH and rapidly progressive vision loss. He was discharged with ongoing management for newly diagnosed biventricular heart failure. Later cardiac catheterization showed elevated wedge pressure and compensated heart failure.<br /><br />The presentation highlights a possible metabolic link between IIH and cardiovascular disease. Proposed shared factors include obesity, androgen excess, centripetal fat distribution, metabolic syndrome, and cardiovascular risk. The key clinical message is that fulminant IIH can progress quickly to irreversible vision loss, so prompt surgical intervention is essential. At the same time, patients with suspected IIH should be evaluated for cardiovascular disease and medically optimized before surgery whenever possible.

Asset Subtitle

Vishmayaa Saravanan

Meta Tag

Author List Priyanka Sridhar, Violetta Laskova, Vishmayaa Saravanan

Category Clinical Vignettes

Concept Fulminant Idiopathic Intracranial Hypertension

Concept Papilledema

Concept Vision Loss

Concept Opening Pressure

Concept Surgical Intervention

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine at Mount Sinai Morningside/West

Presenting Author Vishmayaa Saravanan

Track Adult

Keywords

idiopathic intracranial hypertension

papilledema

morbid obesity

vision loss

biventricular heart failure

volume overload

acetazolamide

ventriculoperitoneal shunt

elevated intracranial pressure

metabolic syndrome

Fulminant Idiopathic Intracranial Hypertension

Papilledema

Vision Loss

Opening Pressure

Surgical Intervention