Fluvoxamine-induced intracranial hypertension in a 10-year-old boy

Drug-induced intracranial hypertension is a well-established entity. We report a rare case of intracranial hypertension with papilledema in a 10-year-old boy following use of fluvoxamine, a selective serotonin reuptake inhibitor. On discontinuing the drug, the papilledema resolved over 4 months without any residual visual anomalies. To the best of our knowledge, this is the first report of fluvoxamine-induced intracranial hypertension with papilledema.

Pseudotumor cerebri in 11 months old child – A case report with review of literature.

Pseudotumor cerebri is defined as a clinical entity where there are signs and symptoms of raised intracranial pressure but the higher mental and neurological functions are not altered. Many times the etiology is unknown. A thorough history and clinical examination is necessary along with exclusion of possible structural causes of intracranial hypertension. Headache, papilledema and visual disturbances are the characteristic symptoms in a child but in a younger infant it becomes all the more difficult to arrive at diagnose. The prognosis is excellent if the offending drug or cause is identified and abated. This case study reported a case of Pseudotumor cerebri (PTC) in 11 months old child.

Vantagens da conservação da veia jugular interna nos esvaziamentos cervicais unilaterais / Advantages of internal jugular vein preservation in unilateral neck dissections

OBJETIVO: Diante da dúvida sobre a existência ou não de vantagens relacionadas à conservação da veia jugular interna nos esvaziamentos cervicais unilaterais resolvemos observar se os pacientes que a tem sacrificada apresentam alterações ao exame de fundo de olho que indiquem um aumento da pressão intracraniana, avaliar a presença de alterações neurológicas e verificar as vantagens na evolução clínico-cirúrgica dos pacientes que tiveram a sua veia jugular interna conservada. MÉTODO: Trata-se de estudo prospectivo, não randomizado, de 15 pacientes portadores de carcinoma epidermóide da cabeça e pescoço, atendidos e operados no Serviço de Cirurgia de Cabeça e Pescoço do Hospital Heliópolis, que tiveram como parte de seu tratamento a realização de esvaziamento cervical completo (funcional ou não) unilateral, divididos em um grupo com ressecção da veia jugular interna e outro com sua conservação. Todos foram submetidos a exames de retinografia pré e pós-operatórios, além de avaliação neurológica e clínica. RESULTADOS: Não ocorreram alterações oftalmológicas detectáveis através da retinografia em nenhum dos grupos. O grupo que teve sua veia jugular interna ressecada apresentou maior incidência de queixas neurológicas no pós-operatório, além de uma evolução cirúrgica mais desfavorável, com um maior período de internação devido às complicações locais apresentadas. CONCLUSÕES: A conservação da veia jugular interna nos esvaziamentos cervicais unilaterais beneficia a evolução pós-operatória dos pacientes, com um menor período de internação, apesar de não termos identificado qualquer evidência pós-operatória de aumento da pressão intracraniana nos pacientes que tiveram a veia ligada.

BACKGROUND: Facing the doubt about the existence or not of advantages in preserving the internal jugular vein (IJV) in unilateral neck dissections, the authors decided to determine if the patients with IJV ligation develop changes in retina examination that indicate an increasing in intracranial pressure, to evaluate the presence of neurologic changes and to verify the advantages on clinical and surgical outcome of the patients with IJV ligation. METHOD: This is a non-radomized, prospective study comprising 15 patients with head and neck squamous carcinoma treated at the Head and Neck Service of Hospital Heliópolis who were submitted to unilateral neck dissection as part of their treatment and divided in two groups: one with ligation of IJV and other with its preservation. All underwent to preoperative and postoperative retinography and clinical and neurological evaluation. RESULTS: Detectable ophthalmologic changes occurred in none of the two groups. The group with IJV ligation presented a larger incidence of neurologic complaints in postoperative period and a less favorable surgical outcome with a larger period of hospitalization due by local complications. CONCLUSIONS: Preservation of IJV in unilateral neck dissections took to a better postoperative outcome with less time of hospitalization even though no evidence of postoperative increasing in intracranial pressure was observed in patients with IJV ligation.

A Case of Benign Intracranial Hypertension (Pseudotumor cerebri) Associated with Systemic Lupus Erythematosus / 대한혈액학회지

Benign intracranial hypertension (BIH) is very rare and its cause is unclear. Raised intracranial pressure in the absence of an intracranial mass or hydrocephalus (BIH or pseudotumor cerebri) has been described in association with many conditions including SLE. Several pathogenic pathways tie BIH with SLE as thrombotic obliteration of cerebral arteriolar and venous systems and immune complex deposition within the arachnoid villi that are responsible for cerebrospinal fluid (CSF) absorption. The diagnosis of BIH was confirmed by increased intracranial pressure in the absence of any abnormal radiological findings of the brain. We report a young woman with SLE and autoimmune thrombocytopenia complicated by BIH which resolved with corticosteroid therapy and osmotic diuretics.

A Case of Benign Intracranial Hypertension in Pseudopseudohypoparathyroidism

We describe a rare case of pseudopseudohypoparathyroidism (PPHP) with benign intracranial hypertension (BIH). A 16 year-old male presented with headache, vomiting, ocular pain, blurred vision, and diplopia following minor head trauma. He showed developmental delay, short stature and short metacarpals and phalanges, which suggested Albright's hereditary osteodystrophy. Neurologic examination revealed bilateral sixth cranial nerve palsy and bilateral papilledema. Lumbar puncure disclosed an elevated opening CSF pressure with normal biochemical and celluar find-ings. However, the levels of serum calcium, phosphorus and parathyroid hormone were within the normal limits and chromosomal analyses were normal. Brain MRI revealed normal ventricular size and no structural abnormality. We concluded that PPHP seemed to have a key role for the genesis of BIH in this case, although previous mild head trauma might have a precipitating effect.

Visual Loss Related to Papilledema:Report of 5 Cases

Five cases of complete visual loss related to papilledema were presented. The diagnoses of cases were an intracranial arachnoid cyst(1 case), brain tumors(3 cases) and benign intracranial hypertension(BIICP) followed by a minor head trauma(1 case). All cases had marked papilledema at admission and their range of age was from 4 to 27 years. The timings of visual loss were preadmission in 2 cases, during admission following removal of posterior fossa tumor(1 case) and revision of cysto-peritioneal shunt in a case of an arachnoid cyst(1 case), and during follow-up after conservative management of a minor head trauma(BIICP) in 1. Their visual function had not improved during the follow-up from 3 months to 9 years. Optic nerve sheath decompression should be considered in the case of BIICP for improving the vision. In cases who have well developed chronic papilledema, visual loss that is abrupt may be followed by cranial decompression. We stress neurosurgeons should predict a tragic outcome of visual loss during the management of cases who have well developed chronic papilledema, especially in children and young adult patients.