Pseudotumor cerebri and thyroid-replacement therapy

Pseudotumor cerebri in an infant after L-thyroxine therapy for transient neonatal hypothyroidism

Pseudotumor cerebri is generally a benign disorder. It has been reported to occur in hypothyroidism, particularly after the initiation of L-thyroxine replacement therapy. Previous case reports have involved children primarily in the peripubertal age range (approximately 8 to 13 years). We report here the development of pseudotumor cerebri in an infant who required treatment with L-thyroxine for transient neonatal hypothyroidism as a result of maternal thyroid-stimulating hormone receptor-blocking antibodies.

Pediatric pseudotumor cerebri (idiopathic intracranial hypertension)

This review focuses on the features of pseudotumor cerebri in the pediatric age group. There is no sex predilection in children, and obesity does not appear to be an important factor. Infants and young children may present with irritability, apathy, or somnolence, rather than headache. Dizziness and ataxia may also occur. Papilledema is infrequently noted in pediatric patients if the fontanelles are open or the sutures are split. Pre-adolescents appear more likely than adults or adolescents to have manifestations of their pseudotumor cerebri other than headache and papilledema, including lateral rectus pareses, vertical strabismus, facial paresis, back and neck pain. Among the etiologies that are particularly pertinent to children are tetracycline therapy, malnutrition or renutrition, and the correction of hypothyroidism. Children with pseudotumor cerebri are at risk for visual loss and their visual function must be closely monitored. Surgical intervention is imperative when vision is threatened.

Retinal haemorrhages and papilloedema due to benign intracranial hypertension in a pregnant diabetic

A case of benign intracranial hypertension associated with generalized oedema is reported in a normotensive pregnant patient with long-standing insulin-treated diabetes mellitus. Following treatment with bed rest, chlorthalidone and dexamethasone the condition resolved and a healthy infant was delivered. This condition, not previously reported in a diabetic pregnancy, must be differentiated from other causes of bilateral optic nerve abnormalities associated with retinal haemorrhages and oedema, including diabetic retinopathy, diabetic optic neuropathy, accelerated hypertension and cerebral mass lesions. Treatment is required to prevent permanent visual impairment due to pressure on the susceptible optic nerve of the diabetic patient and to avoid the metabolic consequences to both mother and fetus of poor nutritional intake due to nausea.