A 29-year-old woman with a BMI of 36 and no significant medical history presented with worsening headaches, nausea, and blurred vision for one week. She had bilateral papilledema and reduced visual acuity. Initial imaging, including  CTA and CTV, showed no significant abnormalities. MRI revealed bilateral posterior scleral flattening, indicative of papilledema. A lumbar puncture confirmed elevated cerebrospinal fluid pressure (>55 cm H2O), leading to the diagnosis of IIH. She was treated with acetazolamide and discharged. Two days later, the patient returned with right-sided ptosis, mydriasis, and complete third nerve palsy. Despite repeat imaging, no structural causes like aneurysms were found. Acetazolamide was discontinued due to concerns over low cerebrospinal fluid pressure, but her vision deteriorated further, becoming limited to finger counting. Repeat LP reconfirmed elevated opening pressure and repeat MRI showed significant venous congestion suggestive of ongoing intracranial hypertension. Intravenous acetazolamide and methylprednisolone were administered, and a lumbar drain was placed, resulting in significant improvement. Eventually, a ventriculoperitoneal shunt was inserted, leading to rapid recovery from ptosis, ophthalmoplegia, and headaches.