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Background: Idiopathic intracranial hypertension (IIH) is characterised by raised intracranial pressure and normal cerebrospinal fluid composition with no detectable intracranial aetiology. Fulminant IIH is rare and is defined by the acute onset of symptoms and signs (less than 4 weeks between onset of symptoms and severe vision loss) with progressive vision loss over days.

Case presentation: A 22-year-old woman with body mass index of 27.6 was diagnosed with fulminant IIH. Her presenting vision was hand movement and it progressed rapidly to no light perception by day 4. She was managed with oral acetazolamide and intermittent lumbar punctures. Nevertheless, she did not regain her vision.

Conclusion: Fulminant IIH is a vision-threatening condition that must be recognised and treated early to prevent irreversible vision loss.