A 27 year-old woman attends the neurology clinic complaining of headache and visual disturbance. She has recently immigrated from Ghana. Her symptoms began approximately one month ago, shortly after the birth of her first child. She experiences dull frontal headache which is worst in the mornings and on coughing or straining, as well as transient episodes of ‘darkening’ of her vision. She saw a doctor in Ghana and was diagnosed with idiopathic intracranial hypertension. She is taking acetazolamide 250mg BD and no other medication.
On examination the visual fields are markedly constricted and the right blind spot is enlarged. Fundoscopy shows bilateral papilloedema worse on the right. The remainder of the neurological examination is unremarkable. BMI is 18 kg/m².
Plain computed tomography of the brain is normal.
Incidentally as she is leaving the clinic she mentions that she has also been experiencing pins and needles in the hands and feet.
What is the best course of action?
Increase dose of acetazolamide
Request nerve conduction studies
Organise for therapeutic lumbar puncture
Refer to neurosurgeons for consideration of ventriculo-peritoneal shunting
Request CT venography