A License to Diagnose: Idiopathic Intracranial Hypertension Unmasked During Driving-License Evaluation

Abstract

Background: Idiopathic intracranial hypertension (IIH) classically presents with headache and visual disturbances; however, some patients remain minimally symptomatic and are identified only through incidental detection of optic disc edema. The prevalence of such presentations remains uncertain, and early recognition is essential to prevent visual morbidity. Case Description: A 23-year-old woman without medical comorbidities underwent ophthalmological evaluation as part of a driving-license assessment. Fundus examination revealed bilateral papilledema, prompting neurological referral. On detailed questioning, she reported only occasional headaches over six months and intermittent right-sided tinnitus, without transient visual obscurations, diplopia, or visual blurring. Neurological examination was otherwise unremarkable. Magnetic resonance imaging demonstrated bilateral optic nerve tortuosity with flattening of the posterior globe on the left side, while magnetic resonance venography was normal. Cerebrospinal fluid analysis showed an opening pressure of 28 cm H₂O with normal cell counts, protein, and glucose levels. Based on modified Friedman diagnostic criteria, a diagnosis of definite IIH was established. Acetazolamide therapy was initiated, and follow-up ophthalmological assessment was planned. Conclusion: This case highlights the importance of evaluating incidentally detected papilledema during routine visual screening. Driving-license examinations may occasionally uncover clinically silent or minimally symptomatic IIH, allowing timely intervention before irreversible visual complications occur.