Optic discs swelling in a child

A teenage girl presented to the hospital emergency department with a three-week history of intermittent frontal headache, which was worse in the morning and associated with nausea, vomiting, lethargy, and poor appetite. She denied any history of tinnitus, dizziness, numbness or weakness of limbs, weight loss, fever, or visual disturbance. She was otherwise fit and well, had normal body mass index, and not taking any medication.

Systemic examination was unremarkable with normal blood pressure at 100/68 mm Hg. Her Snellen visual acuity was 6/6 in both eyes with normal colour vision and normal confrontational visual field test. Pupils were equal and reactive to light and accommodation with no relative afferent pupillary defect. Both anterior segments were normal. Fundus examination showed bilateral optic discs swelling (right Frisén grade 3, left Frisén grade 4)1 with obscuration of major vessels and flame-shaped haemorrhages of the nerve fibre layer. The retinal blood vessels and maculae were otherwise healthy.

Blood tests including full blood count, urea and electrolytes, and inflammatory markers were normal. The patient then underwent urgent magnetic resonance imaging (MRI) of the head and venogram, which were unremarkable. Subsequent lumbar puncture showed raised opening pressure at 32 cm H₂O with normal cerebrospinal fluid constituents.