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Sudhakar M, Kocheril AP, George AS, Vettiyil GI, Jasper A, Kumar S. Idiopathic intracranial hypertension as the initial presenting manifestation of systemic lupus erythematosus in a child. Lupus 2024; 33:759-761. [PMID: 38607271 DOI: 10.1177/09612033241247358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Idiopathic intracranial hypertension (IIH) is a diagnosis of exclusion characterized by features of raised intracranial pressure (ICP) in the absence of brain parenchymal lesion, vascular malformations, hydrocephalus, or central nervous system (CNS) infection. Commonly used other terms for this entity include benign intracranial hypertension (BIH) or pseudotumor cerebri. Few case reports of systemic lupus erythematosus (SLE) presenting as IIH are available in the literature. We report a 12-year-old girl presented with chronic holocranial headache and occasional episodes of projectile vomiting for the last 6 months and then developed blurring of vision for the last month. She fulfilled the criteria for IIH. Subsequent evaluation revealed a diagnosis of SLE. The occurrence of IIH in SLE is not coincidental and is reported in 1%-5.4% of patients with SLE. Though corticosteroids have not been widely used in IIH, underlying SLE warranted administering corticosteroids with subsequent complete resolution of IIH. Pediatricians, neurologists, intensivists, and ophthalmologists should consider SLE as a differential diagnosis in children presenting with IIH.
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Affiliation(s)
- Murugan Sudhakar
- Pediatric Rheumatology, Pediatrics Unit II, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Anu P Kocheril
- Pediatric Rheumatology, Pediatrics Unit II, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Anish S George
- Pediatric Rheumatology, Pediatrics Unit II, Department of Pediatrics, Christian Medical College, Vellore, India
| | - George I Vettiyil
- Pediatric Rheumatology, Pediatrics Unit II, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Anitha Jasper
- Department of Radiology, Christian Medical College, Vellore, India
| | - Sathish Kumar
- Pediatric Rheumatology, Pediatrics Unit II, Department of Pediatrics, Christian Medical College, Vellore, India
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Zou M, Jiang X, Chen H, Yuan F. Systemic lupus erythematosus with chronic persistent intracranial hypertension: A case report. Lupus 2024; 33:293-297. [PMID: 38285490 DOI: 10.1177/09612033241230734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
OBJECTIVE The aim is to investigate the clinical characteristics of systemic lupus erythematosus with intracranial hypertension. METHODS The clinical characteristics of one case of systemic lupus erythematosus with chronic persistent intracranial hypertension were analyzed, and related literature was reviewed by searching Medline and Wanfang databases. RESULTS Intracranial hypertension in SLE patients may occur at the onset or during the course of the disease. Our patient was diagnosed with IH 3 years after the onset of SLE. Headache and papilledema were the most common symptoms of intracranial hypertension, followed by nausea or vomiting, vision changes, and cerebral palsy. Our patient had a headache and cranial hypertension that lasted for years, but no papilledema was found. Corticosteroid is currently the mainstay of the treatment of IIH in patients with SLE, and immunosuppressive agents, acetazolamide, intravenous mannitol and furosemide are also used. However, our patient did not respond to these treatments and presents the characteristics of chronic persistent intracranial hypertension. CONCLUSION Systemic lupus erythematosus with intracranial hypertension is a rare manifestation of SLE, which is not completely parallel to SLE activity. Headache and papilledema were the most common presenting symptoms. Different from previous reported cases, our patient had poor response to treatments, showing chronic and persistent characteristics.
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Affiliation(s)
- Minchao Zou
- Department of Rheumatology and Immunology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Xinyu Jiang
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Haifeng Chen
- Department of Rheumatology and Immunology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Fenghong Yuan
- Department of Rheumatology and Immunology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
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Khan S, Vital EM, Patil A, Currie S, Backhouse O, Alty J. Systemic lupus erythematosus-induced intracranial hypertension: rare but important. Pract Neurol 2022; 22:pn-2022-003424. [PMID: 35850978 DOI: 10.1136/practneurol-2022-003424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Sana Khan
- Department of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Edward M Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ajay Patil
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stuart Currie
- Department of Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Oliver Backhouse
- Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jane Alty
- Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
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Intracranial hypertension with reversible cerebral edema: Atypical presentation of neuropsychiatric systemic lupus erythematosus. Radiol Case Rep 2022; 17:1416-1420. [PMID: 35251427 PMCID: PMC8892015 DOI: 10.1016/j.radcr.2022.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/20/2022] Open
Abstract
We described in this article a 19-year-old girl with an intracranial hypertension as an initial presentation of neuropsychiatric lupus. The brain MRI showed diffuse, bilateral and symmetrical white and grey matter hyperintensities. These lesions completely disappeared after 3 months of treatment. Diffuse cerebral edema with or without leukoencephalopathy in neuropsychiatric systemic lupus erythematosus is an extremely rare entity.
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Figueira S, Thompson A, Garson N, Wood K, Hartenstein B, Maitland C. Idiopathic Intracranial Hypertension and Multiple Sclerosis. Mult Scler Relat Disord 2021; 50:102829. [PMID: 33626432 DOI: 10.1016/j.msard.2021.102829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/05/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
Unexplained elevated intracranial pressure occasionally develops in individuals with Multiple Sclerosis (MS). Visual symptoms and signs are common to both conditions. An awareness of this association is particularly relevant due to the increased incidence of headache in MS and the frequent overlap of symptoms and signs in both conditions.
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Affiliation(s)
| | | | | | | | | | - Charles Maitland
- Florida State University College of Medicine, Department of Clinical Sciences
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Haddad N, Silva L, Yeh S, Colodetti T, Ugolini M, Neto E. PSEUDOTUMOR CEREBRAL NO LÚPUS ERITEMATOSO SISTÊMICO (LES) VERSUS PSEUDOTUMOR CEREBRAL IDIOPÁTICO: DIFERENÇAS NA ABORDAGEM E TRATAMENTO. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abstract
Systemic lupus erythematosus (SLE) can affect any part of the central nervous system (CNS) from the cerebrum to the cauda eqina, giving rise to diverse neurological mainfestations. Despite clinically apparent symptoms and signs, imaging will commonly be normal while at times the magnitude of changesdemonstratedon MRI may be out of proportionto the clinical presentation.We describethe MRI techniques used in CNS imaging and the pattern of presentation in SLE.
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Maloney K. Idiopathic intracranial hypertension as an initial presentation of systemic lupus erythematosus. BMJ Case Rep 2013; 2013:bcr2013010223. [PMID: 23943808 PMCID: PMC3761693 DOI: 10.1136/bcr-2013-010223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 14-year-old girl with no known illness presented with a several week history of headaches and vomiting. The patient also reported having joint pain and swelling to the wrists and knees. She had no prior history of headaches, use of hormonal contraception or other medications, recent weight changes or family history of autoimmune disease. Blood pressure temperature, height and weight were normal. She was alert, there was alopecia, cervical lympadenopathy, symmetrical synovitis to the wrists, bilateral papilloedema and cranial nerve VI palsy. Laboratory investigations revealed a normochromic normocytic anaemia, leucopenia and lymphopenia. Serum chemistries were normal. CT of the brain was normal. Lumbar puncture revealed an opening pressure of greater than 300 mm H2O; cerebrospinal fluid (CSF) analysis was normal. HIV antibodies were non-reactive. Despite treatment with acetazolamide she developed somnolence. Hence MR venography was performed which showed no evidence of cerebral vein thrombosis. Further investigations revealed a positive direct coombs test, positive antinuclear antibodies (ANA) positive antidouble-stranded DNA (dsDNA) and false positive VDRL. Complement levels were reduced. Anti-Smith, anticardiolipin antibodies and lupus anticoagulant were negative.
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Rajasekharan C, Renjith SW, Marzook A, Parvathy R. Idiopathic intracranial hypertension as the initial presentation of systemic lupus erythematosus. BMJ Case Rep 2013; 2013:bcr-2012-007886. [PMID: 23376664 DOI: 10.1136/bcr-2012-007886] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 14-year-old girl was referred for evaluation of headache with episodes of transient blurring of vision, and intermittent fever for 4 weeks. On examination she was conscious and febrile, with multiple annular purpuric skin lesions present over the face and back. Neurological examination revealed a bilaterally extensor plantar response, with bilateral papilloedema. Lumbar puncture yielded clear spinal fluid with a very high opening pressure with a normal biochemistry and cytology. Neuroimaging showed evidence of raised intracranial tension. She was provisionally diagnosed to have idiopathic intracranial hypertension (IIH) and started on anticerebral oedema measures. Despite medication, she continued to be symptomatic. On the sixth day of admission, her antinuclear antibody and antidouble-stranded DNA registered positively in high titres. She was diagnosed with systemic lupus erythematosus (SLE) with IIH and was started on corticosteroids, with dramatic recovery of her symptoms and clinical signs. Reports of SLE, the maiden presentation of which is IIH, are rare in the literature.
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Tse C, Klein R. Intracranial hypertension associated with systemic lupus erythematosus in a young male patient. Lupus 2012; 22:205-12. [DOI: 10.1177/0961203312464804] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Systemic lupus erythematosus (SLE) is a chronic disease that affects multiple organ systems including the central nervous system. We present a case of a young male with a new diagnosis of SLE presenting as intracranial hypertension (IH). Review of the literature suggests an association between SLE and IH and prompts a reconsideration of the exclusion of IH from the American College of Rheumatology’s accepted neuropsychiatric manifestations. In addition, our case is one of the few cases of IH and SLE in males. While the data are limited, SLE-associated IH in males may be different from that in females with respect to presentation and severity.
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Affiliation(s)
- C Tse
- Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - R Klein
- Department of Internal Medicine, Division of General Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Georgakopoulos CD, Kargiotis O, Eliopoulou MI, Makri OE, Exarchou AM, Papathanasopoulos P. Diplopia due to systemic lupus erythematosus in a child: a rare clinical presenting sign of the disease. J Child Neurol 2011; 26:1576-9. [PMID: 21745801 DOI: 10.1177/0883073811412828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present the case of a 14-year-old girl who was admitted to the hospital with the complaint of horizontal diplopia for 48 hours. Initially, she was diagnosed with idiopathic intracranial hypertension. During hospitalization she developed fever, macular facial rash, and chest pain, and because of abnormal laboratory findings the diagnosis of systemic lupus erythematosus was established. She received immunomodulatory therapy, a combination of corticosteroids, and intravenous infusions of the monoclonal antibody rituximab, which augmented her clinical improvement. Intracranial hypertension secondary to systemic lupus erythematosus is a rare manifestation, especially as a presenting symptom. In addition, the fact that the patient developed an aggressive form of systemic lupus erythematosus during the initial period of hospitalization for idiopathic intracranial hypertension is also uncommon. Moreover, to our knowledge, we are not aware of any published case reports of intracranial hypertension secondary to systemic lupus erythematosus that was treated with rituximab.
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Maillart E, Gueguen A, Obadia M, Moulignier A, Vignal-Clermont C, Gout O. Hypertension intracrânienne et lupus. Rev Neurol (Paris) 2011; 167:505-10. [DOI: 10.1016/j.neurol.2010.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 03/19/2010] [Accepted: 10/15/2010] [Indexed: 11/24/2022]
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Barahona-Hernando R, Ríos-Blanco JJ, Méndez-Mesón I, Pérez-Valero I, Soto-Abánades CI, Noval S, Carceller F, Robles-Marhuenda Á, Gil-Aguado A. Idiopathic intracranial hypertension and systemic lupus erythematosus: a case report and review of the literature. Lupus 2009; 18:1121-3. [DOI: 10.1177/0961203309104429] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- R Barahona-Hernando
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - JJ Ríos-Blanco
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - I Méndez-Mesón
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - I Pérez-Valero
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - CI Soto-Abánades
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - S Noval
- Department of Opthalmology, Hospital Universitario La Paz, Madrid, Spain
| | - F Carceller
- Department of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain
| | - Á Robles-Marhuenda
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - A Gil-Aguado
- Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
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Dave S, Longmuir R, Shah VA, Wall M, Lee AG. Intracranial Hypertension in Systemic Lupus Erythematosus. Semin Ophthalmol 2009; 23:127-33. [DOI: 10.1080/08820530801888188] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Increased Intracranial Pressure Related to Systemic Lupus Erythematosus: A 26-year Experience. Semin Arthritis Rheum 2008; 38:110-5. [DOI: 10.1016/j.semarthrit.2007.09.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 09/05/2007] [Accepted: 09/23/2007] [Indexed: 11/18/2022]
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Abstract
PURPOSE OF REVIEW To discuss the current standard in diagnosis and treatment of pseudotumor cerebri (PTC), the syndrome of increased intracranial pressure without a brain tumor. Since PTC is a diagnosis of exclusion, the differential diagnostic work-up is of special importance. RECENT FINDINGS Modern imaging techniques have facilitated the differential diagnosis of PTC. Various therapeutic options are available to prevent irreversible visual loss. New treatment modalities are being explored, but the standard therapy has undergone little change in the past years. SUMMARY PTC, a potentially blinding disease, most commonly manifests with headache and slightly blurred vision due to papilledema. This review seeks to present a methodical approach to its diagnosis and treatment.
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Affiliation(s)
- Michaela K Mathews
- Wills Eye Hospital, Neuro-Ophthalmology Service, Philadelphia, PA 19107, USA.
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