Step 2

Neurology 10

A 22-year-old woman presents to her physician’s office complaining of a persistent headache and blurry vision for approximately 3 months. The patient states that the headache is retro-orbital and bilateral. The patient has been seen before with a history of severe acne refractory to benzoyl peroxide and minocycline, successfully treated 4 months ago with oral isotretinoin. She has no other medical history or allergies. Her last menstrual period was 3 weeks ago, lasting 3 days with no abnormal bleeding. The patient is in a monogamous relationship with her husband, and they use barrier contraception. She does not smoke cigarettes or drink alcohol but occasionally uses marijuana, although she has not used any for the last three months due to her symptoms. Temperature is 99.0°F (37.2°C), blood pressure 126/82 mmHg, pulse 92/min, respirations 16 min, oxygen saturation 98% on room air, 5’10”, and weight 150 pounds. Physical examination shows bilateral papilledema on fundoscopy, with 20/20 vision in both eyes with corrective lenses. She has no rashes, and the examination is otherwise unremarkable. A CT of the brain without contrast is normal. Lumbar puncture shows an opening pressure of 32 cm H2O, and normal CSF with no RBCs or WBCs found.

Which of the following is most likely responsible for the patients’ symptoms?

  • A) Corticosteroids
  • B) Herpes simplex virus encephalitis
  • C) Isotretinoin
  • D) Obesity
  • E) Rupture of the anterior communicating artery


Lloyd Taylor


Dr. Ted O'Connell