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A 46 year old woman with a six year history of IIH presented with pulsatile tinnitus, painless hemifacial spasm, and paresthesias isolated to her right lower face (V3) that occurred exclusively when moving from a sitting to a standing position. Episodes occur several times daily, last for 60 seconds, and remit immediately upon sitting. VA was 20/20; optic discs were swollen, confirmed by optical coherence tomography. Head MRI and IAC MRI with special attention to the posterior fossa were unremarkable.

Orthostatic hemifacial spasm, trigeminal paresthesias, and pulsatile tinnitus together in the setting of IIH have not been previously reported. This case adds to the spectrum of occult symptoms occurring in IIH, thus improving rare symptom recognition and patient outcomes. The dynamics of anatomic shift and volume redistribution in the context of these symptoms will be discussed.