A 30-year-old woman presents with a history of recurrent headaches of variable location associated with new blurred vision and diplopia. She reports associated nausea and vomiting. She denies trauma, eye pain, photophobia, numbness, or weakness.
Her vital signs are normal. Findings on the neurologic examination are normal except for limited lateral eye movement and diplopia with horizontal gaze consistent with a sixth cranial nerve palsy. Conjunctiva is clear. Pupils are equally round and reactive to light. Visual acuity is 20/40 OD, OS, and OU.
Findings on the funduscopic examination are as shown in the image below.
Computed tomography (CT) of the brain is unremarkable.
Which test is most useful in determining the patient’s diagnosis?
References:
Gans MS. Idiopathic intracranial hypertension. Medscape. [Oct 28, 2021].
Kwiatkowski T, Friedman BW. Headache disorders. In: In: Walls M, et al. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed., 2018:11265-1277.e2.
This question appears in Med-Challenger Emergency Medicine Review with CME
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