Unusual Presentation of Acute Lymphoblastic Leukemia Masquerading Idiopathic Intracranial Hypertension
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Abstract
Idiopathic intracranial hypertension (IIH) is defined as increased cerebrospinal fluid (CSF) opening pressure and abnormal fundoscopy when other causes of increased intracranial pressure are ruled out. We present a patient with a primary diagnosis of IIH who had undergone a lumboperitoneal shunt. Later she was treated with shunt revision, anti-tuberculosis drugs, and intravenous immunoglobulin. Acute lymphoblastic leukemia (ALL) was diagnosed after bone marrow biopsy. The initial response to chemotherapy was promising. Careful history taking, avoidance of unnecessary repetition of diagnostic procedures, avoidance of a tunneled vision, and a strong clinical suspicion is important to see the hidden causes underlying a difficult case of pseudotumor cerebri. Acute lymphoblastic leukemia and carcinomatous meningitis should be sought in IIH patients with abnormal presentation and unusual response to the known treatments.
1. Mulroy E, Krishnan T, Best S, Anderson NE. Forgetting the fundoscope–A case of fulminant idiopathic intracranial hypertension causing rapid visual loss. Journal of Clinical Neuroscience. 2018 Apr 1;50:108-10.
2. Winters HS, Parker G, Halmagyi GM, Mehta A, Atkins T. Delayed relapse in pseudotumor cerebri due to new stenosis after transverse sinus stenting. Journal of neurointerventional surgery. 2015 Sep 14.
3. Ding D, Chen CJ, Starke RM, Liu KC, Crowley RW. Rapid recovery of bilateral abducens nerve palsies after venous sinus stenting for idiopathic intracranial hypertension. Journal of the neurological sciences. 2015 Oct 15;357(1):335-7.
4. Smith SV, Friedman DI. The idiopathic intracranial hypertension treatment trial: a review of the outcomes. Headache: The Journal of Head and Face Pain. 2017 Sep;57(8):1303-10.
5. Ahmed RM, Wilkinson M, Parker GD, Thurtell MJ, Macdonald J, McCluskey PJ, Allan R, Dunne V, Hanlon M, Owler BK, Halmagyi GM. Transverse sinus stenting for idiopathic intracranial hypertension: a review of 52 patients and of model predictions. American Journal of Neuroradiology. 2011 Jul 27.
6. Halmagyi GM, Ahmed RM, Johnston IH. The pseudotumor cerebri syndrome: a unifying pathophysiological concept for patients with isolated intracranial hypertension with neither mass lesion nor ventriculomegaly. Neuro-Ophthalmology. 2014 Oct 1;38(5):249-53.
7. Bhandohal JS, Mirza T. BLIND OVERNIGHT: A case of fulminant idiopathic intracranial hypertension. The American journal of emergency medicine. 2017 Oct 1;35(10):1581-e1.
8. Voldman A, Durbin B, Nguyen J, Ellis B, Leys M. Fulminant idiopathic intracranial hypertension and venous stasis retinopathy resulting in severe bilateral visual impairment. European journal of ophthalmology. 2017 Mar 10;27(2):25-7.
9. Abdelfatah MA. Normal Pressure Pseudotumor Cerebri: A Series of Six Patients. Turkish neurosurgery. 2017 Mar 1;27(2).
10. Suh SY, Kim SJ. IIH with normal CSF pressures?. Indian journal of ophthalmology. 2013 Nov;61(11):681.
11. González-Andrades M, García-Serrano JL, González Gallardo MD, Mcalinden C. Multiple cranial nerve involvement with idiopathic intracranial hypertension. QJM: An International Journal of Medicine. 2015 Dec 28;109(4):265-6.
12. Soroken C, Lacroix L, Korff CM. Combined VIth and VIIth nerve palsy: Consider idiopathic intracranial hypertension!. european journal of paediatric neurology. 2016 Mar 1;20(2):336-8.
13. Pacca P, Altieri RO, Zenga F, Garbossa DI, Ducati AL, Lanotte M. Is Pseudotumor Cerebri An Unusual Expression of Chiari Syndrome? A Case Report and Review of the Literature. Surgical technology international. 2017 Jul 25;30:486-9.
14. Meeker AR, Ko MW, Carruth BP, Strumpf KB, Bersani TA. Diagnosis of optic nerve sheath meningioma during optic nerve sheath decompression. Orbit. 2017 Jan 2;36(1):35-8.
15. Masumoto A, Yamamoto K, Umemura T, Kaneko S, Motomura S, Ibayashi H, Otsuka M. A case of idiopathic autoimmune hemolytic anemia associated with benign intracranial hypertension. [Rinsho ketsueki] The Japanese journal of clinical hematology. 1984 Apr;25(4):575.
16. Bonfield CM, Tamber MS, Losee JE. Blindness from late presenting undiagnosed pancraniosynostosis mimicking pseudotumor cerebri. Journal of child neurology. 2014 Aug;29(8):NP24-7.
17. Jabbour E, Thomas D, Cortes J, Kantarjian HM, O'brien S. Central nervous system prophylaxis in adults with acute lymphoblastic leukemia: current and emerging therapies. Cancer. 2010 May 15;116(10):2290-300.
18. Moosa A, Joy M, Kumar A. Pseudotumour cerebri and Guillain-Barre syndrome: cause or effect?. Neurology India. 2003 Apr 1;51(2).
19. Vembu P, Al-Shubaili A, Al-Khuraibet A, Kreze O, Pandita R. Guillain-Barré Syndrome in a Case of Acute Lymphoblastic Leukaemia. Medical Principles and Practice. 2003;12(4):272-5.
2. Winters HS, Parker G, Halmagyi GM, Mehta A, Atkins T. Delayed relapse in pseudotumor cerebri due to new stenosis after transverse sinus stenting. Journal of neurointerventional surgery. 2015 Sep 14.
3. Ding D, Chen CJ, Starke RM, Liu KC, Crowley RW. Rapid recovery of bilateral abducens nerve palsies after venous sinus stenting for idiopathic intracranial hypertension. Journal of the neurological sciences. 2015 Oct 15;357(1):335-7.
4. Smith SV, Friedman DI. The idiopathic intracranial hypertension treatment trial: a review of the outcomes. Headache: The Journal of Head and Face Pain. 2017 Sep;57(8):1303-10.
5. Ahmed RM, Wilkinson M, Parker GD, Thurtell MJ, Macdonald J, McCluskey PJ, Allan R, Dunne V, Hanlon M, Owler BK, Halmagyi GM. Transverse sinus stenting for idiopathic intracranial hypertension: a review of 52 patients and of model predictions. American Journal of Neuroradiology. 2011 Jul 27.
6. Halmagyi GM, Ahmed RM, Johnston IH. The pseudotumor cerebri syndrome: a unifying pathophysiological concept for patients with isolated intracranial hypertension with neither mass lesion nor ventriculomegaly. Neuro-Ophthalmology. 2014 Oct 1;38(5):249-53.
7. Bhandohal JS, Mirza T. BLIND OVERNIGHT: A case of fulminant idiopathic intracranial hypertension. The American journal of emergency medicine. 2017 Oct 1;35(10):1581-e1.
8. Voldman A, Durbin B, Nguyen J, Ellis B, Leys M. Fulminant idiopathic intracranial hypertension and venous stasis retinopathy resulting in severe bilateral visual impairment. European journal of ophthalmology. 2017 Mar 10;27(2):25-7.
9. Abdelfatah MA. Normal Pressure Pseudotumor Cerebri: A Series of Six Patients. Turkish neurosurgery. 2017 Mar 1;27(2).
10. Suh SY, Kim SJ. IIH with normal CSF pressures?. Indian journal of ophthalmology. 2013 Nov;61(11):681.
11. González-Andrades M, García-Serrano JL, González Gallardo MD, Mcalinden C. Multiple cranial nerve involvement with idiopathic intracranial hypertension. QJM: An International Journal of Medicine. 2015 Dec 28;109(4):265-6.
12. Soroken C, Lacroix L, Korff CM. Combined VIth and VIIth nerve palsy: Consider idiopathic intracranial hypertension!. european journal of paediatric neurology. 2016 Mar 1;20(2):336-8.
13. Pacca P, Altieri RO, Zenga F, Garbossa DI, Ducati AL, Lanotte M. Is Pseudotumor Cerebri An Unusual Expression of Chiari Syndrome? A Case Report and Review of the Literature. Surgical technology international. 2017 Jul 25;30:486-9.
14. Meeker AR, Ko MW, Carruth BP, Strumpf KB, Bersani TA. Diagnosis of optic nerve sheath meningioma during optic nerve sheath decompression. Orbit. 2017 Jan 2;36(1):35-8.
15. Masumoto A, Yamamoto K, Umemura T, Kaneko S, Motomura S, Ibayashi H, Otsuka M. A case of idiopathic autoimmune hemolytic anemia associated with benign intracranial hypertension. [Rinsho ketsueki] The Japanese journal of clinical hematology. 1984 Apr;25(4):575.
16. Bonfield CM, Tamber MS, Losee JE. Blindness from late presenting undiagnosed pancraniosynostosis mimicking pseudotumor cerebri. Journal of child neurology. 2014 Aug;29(8):NP24-7.
17. Jabbour E, Thomas D, Cortes J, Kantarjian HM, O'brien S. Central nervous system prophylaxis in adults with acute lymphoblastic leukemia: current and emerging therapies. Cancer. 2010 May 15;116(10):2290-300.
18. Moosa A, Joy M, Kumar A. Pseudotumour cerebri and Guillain-Barre syndrome: cause or effect?. Neurology India. 2003 Apr 1;51(2).
19. Vembu P, Al-Shubaili A, Al-Khuraibet A, Kreze O, Pandita R. Guillain-Barré Syndrome in a Case of Acute Lymphoblastic Leukaemia. Medical Principles and Practice. 2003;12(4):272-5.
| Files | ||
| Issue | Vol 57, No 10 (2019) | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/acta.v57i10.3250 | |
| Keywords | ||
| Idiopathic intracranial hypertension Acute lymphoblastic leukemia Lumboperitoneal shunt Paraplegia Pseudotumor cerebri | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Jahanbakhshi A, Fattahi A, Najafi M. Unusual Presentation of Acute Lymphoblastic Leukemia Masquerading Idiopathic Intracranial Hypertension. Acta Med Iran. 2020;57(10):614-617.
