Choroidal infarction in fulminant idiopathic intracranial HT
Published in the Journal of Neuro-Ophthalmology, the authors present a unique case of idiopathic intracranial hypertension (IIH) in which vision loss likely occurred from a variety of mechanisms, including an acute choroidal infarction.

A 20 year-old woman complained of severe headaches with nausea, photophobia and pulsatile tinnitus. For the past week, she had noticed rapidly progressive visual loss in both eyes with severe constriction of her peripheral visual field. Review of systems was remarkable only for recent weight gain of 20 pounds over the previous year.

Visual acuity was 20/20 in the right eye and 20/30 in the left eye. Humphrey and Goldmann visual fields showed bilateral constriction with an inferior nasal defect and enlarged blind spot in the right eye and an inferior altitudinal defect in the left eye.

Funduscopic examination revealed bilateral severe optic nerve head edema with peripapillary hemorrhages and white nerve fiber layer infarctions. In the left eye, there was an area of juxtapapillary whitening extending to the macula, which appeared deep in the retina or subretina.

A fluorescein angiography (FA) demonstrated normal choroidal, arterial and venous filling 25 seconds after injection of fluorescein and normal retina (no mask effect, no edema), ruling out a branch retinal artery or cilioretinal artery occlusion. Indocyanine green (ICG) videoangiography demonstrated a choroidal perfusion defect matching the white patch seen in the left ocular fundus, confirming a choroidal infarction.

Major takeaways:-
- Immediate recognition of the mechanism of visual loss in patients with papilledema is essential in making appropriate therapeutic decisions.

- Choroidal infarction should be added to the list of rare complications of severe papilledema.

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