DISK EDEMA IN AN OVERWEIGHT WOMAN

A 46-year-old extremely obese black woman presented with headaches, bl urred vision, and visual obscurations. Her exam was notable for bilate ral severe papilledema, retinal hemorrhages, and lethargy. Her CAT sca n was normal, and a spinal tap revealed a very high opening pressure. Although this patient's presentation mimicked pseudotumor cerebri, the lethargy and retinal hemorrhages were atypical. Her hospital evaluati on was notable for elevation of the serum bicarbonate level, and she w as subsequently found to have hypoxia and hypercapnia on a blood gas. The patient was diagnosed as Pickwickian syndrome, with obstructive sl eep apnea. Treatment of the pulmonary problem resulted in dramatic imp rovement in her eye findings and her lethargy, and optic nerve sheath fenestration was not necessary.