Bilateral Buried Optic Nerve Head Drusen Mimicking Idiopathic Intracranial Hypertension

Abstract

Optic nerve head (ONH) drusen are buried deposits in the optic nerve head simulating papilloedema. Idiopathic Intracranial Hypertension (IIH) signifies raised intracranial pressure in the absence of intracranial space occupying lesion. A 35-year old woman diagnosed elsewhere with IIH and treated with oral acetazolamide for six months, presented with non-specific headache. Fundus showed bilateral blurring of disc margins, elevated disc and obscuration of cup. MRI of brain was normal. The non-resolution of disc edema despite six months of acetazolamide therapy raised suspicion of an alternate diagnosis. Ultrasound B-scan confirmed the diagnosis of ONH drusen. ONH drusen should be excluded before entertaining the diagnosis of IIH.