A 23- year-man post female to male (FTM) gender transition was found to have bilateral papilloedema at a routine optician visit. The patient was referred on for formal ophthalmological and neurological assessments. Optical coherence tomography (OCT) confirmed the presence of bilateral papilloedema. The patient was entirely asymptomatic and had no medical history. He took testosterone intramuscularly once per month. Neurological examination was otherwise normal. Investigations including routine blood panels, CT brain, MRI brain and cerebral MR venogram were all normal. Lumbar puncture yielded cerebrospinal fluid (CSF) normal in appearance but demonstrated raised intracranial pressure. In the absence of other causative aetiologies a diagnosis of idiopathic intracranial hypertension (IIH) was made. Treatment was commenced with acetazolamide and the patient was discharged with outpatient ophthalmological and neurological follow-up.

and ConclusionsOne hundred and seventeen survivors of a first attack of acute coronary heart disease had blood carboxyhaemoglobin levels checked and smoking histories recorded. All were participants in a longterm follow-up and secondary prevention programme. At last follow-up, four to eighteenyears after the initial attack, 35 stated that they were still smoking, 57 claimed to be ex-smokers, 6 were non -smokers and 19 were pipe or cigar smokers.Thirty-one of the 35 current smokers had a COHb concentration which exceeded 1.6 %. Five of the ex-smokers had concentrations between 1.6 and 2.3%. There was a low and possibly zero deception rate amongst the ex-smokers. This may reflect a high degree of rapport achieved between patients and medical staff during an exceptionally long and regularfollow-upperiod.