Idiopathic Intracranial Hypertension Presenting With Reversible Hemiparesis: A Rare Stroke Mimic.

Idiopathic intracranial hypertension (IIH) presenting with focal neurological deficits is rare and may mimic acute stroke, complicating timely diagnosis. We report the case of a 43-year-old Malay woman with progressive headache, intermittent visual symptoms, and acute-onset, progressive right-sided weakness over two days. Dilated fundus examination revealed bilateral grade 2 papilledema, and neurological examination showed mild hemiparesis. Non-contrast CT and CT angiography of the brain were normal. Lumbar puncture (LP) demonstrated elevated opening pressure with normal CSF findings. She improved significantly following LP and acetazolamide, with complete resolution of hemiparesis within one week. This uncommon presentation highlights the importance of prompt neuroimaging, early ophthalmological assessment, and LP. IIH should be considered in patients with persistent headache and acute hemiparesis once structural and vascular causes have been excluded.