Idiopathic intracranial hypertension exacerbated by aseptic meningitis from a nonsteroidal anti-inflammatory drug

Purpose: To report a case of hemorrhagic papilledema due to idiopathic intracranial hypertension, which was precipitated by aseptic meningitis from self-medication with a nonsteroidal anti-inflammatory drug (NSAID). Observations: A 29-year-old woman with obesity developed headache, emesis, and vision loss. Examination showed swollen optic discs surrounded by extensive hemorrhage. Neuroimaging revealed a partially empty sella, dilated optic nerve sheaths, and stenosis at the transverse-sigmoid sinus junction. A lumbar puncture yielded an elevated intracranial pressure (ICP), along with the unexpected finding of an aseptic meningitis. It was attributed to the patient's excessive use of ibuprofen to treat her headache. Conclusions and importance: Aseptic meningitis induced by an NSAID can precipitate an attack of idiopathic intracranial hypertension in a person at risk for this condition. Inflammatory cells in the meninges impair the absorption of cerebrospinal fluid (CSF), causing a rise in ICP that initiates the positive feedback cycle responsible for the pathogenesis of idiopathic intracranial hypertension.