BC is a 13-year-old girl who saw an optometrist with the complaint of headaches and difficulty in seeing the board in school. She was found to be slightly myopic, but he noted swelling of the optic nerves on examination and referred her for an MRI scan and scheduled a neurology consultation. The MRI scan was reported to be normal, as was the neurological examination. The neurologist made a presumptive diagnosis of pseudotumor cerebri and performed a spinal tap, which showed a slightly elevated opening pressure. She was begun on oral diamox but discontinued it after a week due to the side effects. Another carbonic anhydrase inhibitor was tried with the same result. She was then given Lasix without improvement of her headaches and no change in the optic nerve elevation. She was finally seen by a neuro-ophthalmologist who requested an ultrasound.
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