Idiopathic intracranial hypertension presenting with obsessive thoughts: a rare neuropsychiatric manifestation "case report".

BACKGROUND

Idiopathic intracranial hypertension (IIH) classically presents with headache, papilledema, and visual disturbances. Psychiatric manifestations are rare and may obscure a timely diagnosis.

CASE PRESENTATION: A 23-year-old obese female with no prior psychiatric history presented with new-onset intrusive thoughts and compulsive finger-tapping rituals, leading to a diagnosis of obsessive-compulsive disorder (OCD). Despite treatment with high-dose SSRIs, antipsychotic augmentation, and cognitive-behavioural therapy for six months, she showed no improvement. She concurrently reported a refractory bitemporal headache, tinnitus, and transient visual obscurations. Examination revealed bilateral papilledema. MRI/MRV showed features of raised intracranial pressure (ICP) associated with right transverse sinus stenosis. Lumbar puncture (LP) confirmed an elevated opening pressure of 30 cm H₂O. Despite treatment with acetazolamide (2 g/day), she remained symptomatic. Venous sinus stenting was subsequently performed, restoing sinus caliber and reducing the pressure gradient. Within three months, her headache improved markedly, and her papilledema resolved. Remarkably, her obsessive thoughts and compulsive acts completely disappeared without psychiatric medication, with her Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score dropping from 20 to 5.

CONCLUSION

This case illustrates IIH presenting with predominant psychiatric manifestations mimicking primary OCD. The dramatic resolution of compulsive symptoms following intracranial pressure normalization suggests a possible association between IIH and obsessive thoughts. Clinicians should maintain a high index of suspicion for IIH in atypical psychiatric presentations accompanied by headache, tinnitus, or visual symptoms; in such cases, routine fundoscopy is essential.