Woman presents with bilateral optic nerve edema

A 30-year-old woman was referred to the New England Eye Center neuro-ophthalmology service for evaluation of bilateral optic disc swelling found incidentally during her annual eye examination.
Her ocular history was notable only for a refractive error, for which she wore contact lenses. Her medical history included a long-standing seizure disorder, for which she had had multiple normal MRIs, obesity (BMI of 42), polycystic ovary syndrome, temporomandibular joint dysfunction (TMJ) and generalized anxiety disorder. Review of systems revealed frequent stable headaches thought to be secondary to

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