Name

Œdème papillaire unilatéral dû à Hypertension intracrânienne idiopathique (HII) coexistait avec un syndrome des taches blanches évanescentes et multiples (MEWDS). Cas clinique

To report the co-existence of two non-related different pathologies, we are reporting a case of unilateral papilledema due to idiopathic intracranial hypertension (IIH) which later on the same particular eye and the same particular patient developed another rare pathology namely Multiple Evanescent White Dot Syndrome (MEWDS).

Idiopathic intracranial hypertension (IIH) known previously as (pseudotumor cerebri) is defined as increase intracranial pressure with no detectable cause and usually affects about 2 in 100000 person worldwide, most commonly females aged from 20 to 50 years old.

Our second co-existed pathology is called Multiple evanescent white dot syndrome (MEWDS) is a unilateral chorioretinitis characterized by multiple small sub-retinal white dots extending from the posterior pole to the mid-periphery.

We report a case of 31 years old female patient with a history of morbid obesity treated surgically by gastric ring three years prior to the presentation to our clinic and referred as a suspicion of IIH, with a mild decrease of right eye vision, our  Fundus examination revealed right eye unilateral papilledema, an OCT showed right eye unilateral papilledemaassociated with headache and tinnitus. ,MRI ruled out structural and obstructive lesions as possible causes and lumber puncture showed an increased opening pressure .

The patient was diagnosed with IIH and we started treatment with  acetazolamide and referred to a dietitian to control weight.

Follow up showed progressive papilledema disappearance and the patient recovered a normal vision with no headache nor tinnitus

Two years later the patient complained of a mild decrease blurry vision of right eye with no headache or tinnitus, no pain, no nausea or any other signs of raised intracranial pressure. , the patient weight was controlled since the last visit.

Slit-lamp examination showed a normal anterior segment in both eyes. Fundus examination showed a multiple discrete grayish-white spots measures about 100 to 200 µm in diameter just outside the macula extending to the mid‐peripheral retina with a disc oedema.

We have also performed FA which showed a wreath-like configurations strongly suggesting the diagnosis of MEWDS

No treatment was given to patient.  Regular follow up showed recovery within 3 months

Both Idiopathic intracranial pressure and MEWDS manifests with papilledema, which made our case report a challenging diagnosis in wether the unilateral papilledema was due to the raised intracranial pressure or due to entirely other disease especially in following up a patient with known history of IIH who developed MEWDS at the same particular eye, hence the management of papilledema differ between both pathologies.

Obtaining a careful history along with a careful examination can results in a proper diagnosis, and more targeted management.

We conclude the necessity of considering the co-existence of two different pathologies at the same particular patient and the same particular eye, identifying such a pathologies totally changes the treatment and the follow up planning for such a patient especially for those who are followed up over a long period and appear with a similar complain of their known disease but yet entirely different underlying pathology and eventually different treatment strategies