RESUMO
Pseudotumor cerebri is a syndrome characterized by an elevated intracranial pressure greater than 20 cmH2O with ventricles and cerebrospinal fluid of normal characteristics. Consumption of minocycline have been described among the causes associated with this syndrome. We present a 13-year old female patient with a history of acne treated with minocycline who began with severe headache, diplopia and blurred vision. The diagnosis of pseudotumor cerebri was made, indicating the immediate antibiotic suspension and the beginning of the treatment with acetazolamide. Although the pathogenesis of pseudotumor cerebri is not fully known, an association with minocycline has been observed. This antibiotic is often used by health professionals for the management of acne, so it is important to consider its complications before being prescribed.
El pseudotumor cerebral se caracteriza por una elevación de la presión intracraneal mayor de 20 cmH2O, con ventrículos y líquido cefalorraquídeo de características normales. El consumo de minociclina es una de las causas asociadas a este síndrome. Presentamos una paciente de 13 años de edad con antecedentes de acné tratado con minociclina. Comenzó con cefalea intensa, diplopía y visión borrosa. Se constató el diagnóstico de pseudotumor cerebral y se indicó la suspensión inmediata del antibiótico y el inicio del tratamiento con acetazolamida. Aunque la patogénesis de pseudotumor cerebral no es totalmente conocida, se ha observado una asociación con el empleo de minociclina. Este antibiótico es de uso frecuente para el manejo del acné, por lo que es importante considerar sus complicaciones antes de ser prescrito.
Assuntos
Antibacterianos/efeitos adversos , Minociclina/efeitos adversos , Pseudotumor Cerebral/induzido quimicamente , Pseudotumor Cerebral/diagnóstico , Acne Vulgar/tratamento farmacológico , Adolescente , Antibacterianos/uso terapêutico , Feminino , Humanos , Minociclina/uso terapêuticoRESUMO
El pseudotumor cerebral se caracteriza por una elevación de la presión intracraneal mayor de 20 cmH2O, con ventrículos y líquido cefalorraquídeo de características normales. El consumo de minociclina es una de las causas asociadas a este síndrome. Presentamos una paciente de 13 años de edad con antecedentes de acné tratado con minociclina. Comenzó con cefalea intensa, diplopía y visión borrosa. Se constató el diagnóstico de pseudotumor cerebral y se indicó la suspensión inmediata del antibiótico y el inicio del tratamiento con acetazolamida. Aunque la patogénesis de pseudotumor cerebral no es totalmente conocida, se ha observado una asociación con el empleo de minociclina. Este antibiótico es de uso frecuente para el manejo del acné, por lo que es importante considerar sus complicaciones antes de ser prescrito.
Pseudotumor cerebri is a syndrome characterized by an elevated intracranial pressure greater than 20 cmH2O with ventricles and cerebrospinal fluid of normal characteristics. Consumption of minocycline have been described among the causes associated with this syndrome. We present a 13-year old female patient with a history of acne treated with minocycline who began with severe headache, diplopia and blurred vision. The diagnosis of pseudotumor cerebri was made, indicating the immediate antibiotic suspension and the beginning of the treatment with acetazolamide. Although the pathogenesis of pseudotumor cerebri is not fully known, an association with minocycline has been observed. This antibiotic is often used by health professionals for the management of acne, so it is important to consider its complications before being prescribed.
Assuntos
Humanos , Feminino , Adolescente , Pseudotumor Cerebral/diagnóstico , Pseudotumor Cerebral/induzido quimicamente , Acne Vulgar/tratamento farmacológico , Minociclina/efeitos adversos , Minociclina/uso terapêutico , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêuticoRESUMO
Benign intracranial hypertension (Pseudotumor cerebri) has been described as related to the reduction in steroid levels in Cushing's disease (CD), especially after surgical remission. Ketoconazole is a common and effective adjuvant therapy for hypercortisolism, but the major concern is liver enzyme dysfunction. We describe here the case of a 12-year old girl with CD who developed benign intracranial hypertension during treatment with ketoconazole. She presented headache, vomiting, a black spot on her right temporal visual field, and signs of elevated intracranial pressure. Pituitary image was normal on magnetic resonance image (MRI), and all symptoms improved after treatment with acetazolamide. We call attention to the diagnosis of this disorder in CD patients, especially children on ketoconazole treatment, because it could be confounded with adrenal insufficiency and lead to definitive severe visual impairment.
Assuntos
Cetoconazol/efeitos adversos , Hipersecreção Hipofisária de ACTH/tratamento farmacológico , Pseudotumor Cerebral/induzido quimicamente , Insuficiência Adrenal/diagnóstico , Criança , Diagnóstico Diferencial , Feminino , Humanos , Pseudotumor Cerebral/diagnósticoRESUMO
Benign intracranial hypertension (Pseudotumor cerebri) has been described as related to the reduction in steroid levels in Cushing's disease (CD), especially after surgical remission. Ketoconazole is a common and effective adjuvant therapy for hypercortisolism, but the major concern is liver enzyme dysfunction. We describe here the case of a 12-year old girl with CD who developed benign intracranial hypertension during treatment with ketoconazole. She presented headache, vomiting, a black spot on her right temporal visual field, and signs of elevated intracranial pressure. Pituitary image was normal on magnetic resonance image (MRI), and all symptoms improved after treatment with acetazolamide. We call attention to the diagnosis of this disorder in CD patients, especially children on ketoconazole treatment, because it could be confounded with adrenal insufficiency and lead to definitive severe visual impairment.
Hipertensão intracraniana benigna (Pseudotumor cerebral) tem sido descrita relacionada à redução dos níveis de esteroides séricos na doença de Cushing (DC), especialmente após a remissão cirúrgica. O cetoconazol é uma opção efetiva e de uso rotineiro como adjuvante na terapêutica do hipercortisolismo, tendo como paraefeito mais temido a toxicidade hepática. Relatamos o caso de uma menina com 12 anos de idade portadora de DC que desenvolveu hipertensão intracraniana benigna durante tratamento com cetoconazol. Apresentou-se com cefaleia, vômitos, comprometimento do campo visual temporal direito e sinais de hipertensão intracraniana. A ressonância magnética (RM) de hipófise era normal e todos os sinais e sintomas resolveram-se com uso de acetazolamida. Chamamos a atenção para esse diagnóstico nos pacientes com DC, especialmente crianças, em tratamento com cetoconazol, porque ele pode ser confundido com insuficiência adrenal e causar comprometimento visual severo e definitivo.
Assuntos
Criança , Feminino , Humanos , Cetoconazol/efeitos adversos , Hipersecreção Hipofisária de ACTH/tratamento farmacológico , Pseudotumor Cerebral/induzido quimicamente , Insuficiência Adrenal/diagnóstico , Diagnóstico Diferencial , Pseudotumor Cerebral/diagnósticoRESUMO
Pseudotumor cerebral (PC) é uma síndrome, caracterizada pela presença de hipertensão intracraniana (HIC) e sistema ventricular normal. Pacientes submetidos a transplante renal parecem ser mais suscetíveis a desenvolvê-la. devido á terapia com imunossupressores. Ciclosporina (CsA) é uma causa rara de PC, pouco descrita na literatura e que deve ser lembrada no diagnóstico diferencial de HIC e papiledema nesses pacientes. relatamos um caso de um menino de 10 anos, há três anos com enxerto renal, em uso crônico de micofenolato mofetil (MMF), CsA e baixas doses de prednisona que apresentou quadro de cefaléia, vômitos, diplopia e fotofobia. Fundoscopia revelou edema de papila bilateral. Exame do líquor (LCR) e de imagem foram normais. Após exclusão de causas secundárias, foi feito diagnóstico de PC devido ao uso crônico de CsA, que, portanto, foi substituída por Sirolimus. O paciente apresentou melhora clínica progressiva, com resolução do papiledema após três meses.
Pseudotumor cerebri (PC) is a syndrome characterized by the presence of intracranial hypertension (ICH) and normal ventricular system. Patients undergoing renal transplantation appear to be more susceptible to developing it. due to immunosuppressive therapy. Cyclosporine (CsA) is a rare cause of CP is rarely described in literature and should be considered in the differential diagnosis of ICH in these patients and papilledema. report a case of a boy of 10 years, three years ago with renal graft in chronic use of mycophenolate mofetil (MMF), CsA and low doses of prednisone who developed headache, vomiting, diplopia and photophobia. Fundoscopy revealed bilateral optic disc edema. Examination of cerebrospinal fluid (CSF) and imaging were normal. After exclusion of secondary causes, was diagnosed with PC due to chronic use of CsA, which was therefore replaced by sirolimus. The patient presented progressive clinical improvement, with resolution of papilledema after three months.
Assuntos
Humanos , Masculino , Criança , Ciclosporina/efeitos adversos , Pseudotumor Cerebral/induzido quimicamente , Transplante de Rim/efeitos adversosRESUMO
Pseudotumor cerebri (PC) is a syndrome characterized by the presence of intracranial hypertension (ICH) and no alteration in the ventricular system. Renal transplanted patients seem more susceptible to develop it due to immunosuppressive therapy. Cyclosporin (CsA) is a rare cause of PC, scarcely reported in the literature, and should be considered in the differential diagnosis of ICH and papilledema in those patients. We report the case of a 10-year-old boy, with a renal allograft for three years, on chronic use of mycophenolate mophetil (MMF), CsA, and low doses of prednisone. The patient presented with headache, vomiting, diplopia, and photophobia. Funduscopy showed bilateral papilledema. Cerebrospinal fluid analysis and imaging tests were normal. After excluding secondary causes, PC was diagnosed based on the chronic use of CsA, which was then replaced by sirolimus. After that, the patient progressively improved, and the papilledema resolved in three months.
Assuntos
Ciclosporina/efeitos adversos , Imunossupressores/efeitos adversos , Transplante de Rim , Complicações Pós-Operatórias/induzido quimicamente , Pseudotumor Cerebral/induzido quimicamente , Criança , Humanos , MasculinoRESUMO
We present the case of a 30 year old woman with HIV/AIDS who experienced a 47 percent weight gain over a period of a year after commencing treatment with highly active anti-retroviral therapy (HAART) and went on to develop benign intracranial hypertension (BIH). She was not on any other medication associated with BIH. Although weight gain has been reported in patients on treatment with protease inhibitors, such gains have been minimal to moderate. We are unaware of any previous report of this degree of weight gain or BIH in a patient on protease inhibitors.(Au)
Assuntos
Adulto , Relatos de Casos , Feminino , Humanos , Pseudotumor Cerebral/induzido quimicamente , Aumento de Peso/efeitos dos fármacos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Pseudotumor Cerebral/induzido quimicamenteRESUMO
We present the case of a 30-year-old woman with HIV/AIDS who experienced a 47% weight gain over a period of a year after commencing treatment with highly active anti-retroviral therapy (HAART) and went on to develop benign intracranial hypertension (BIH). She was not on any other medication associated with BIH. Although weight gain has been reported in patients on treatment with protease inhibitors, such gains have been minimal to moderate. We are unaware of any previous report of this degree of weight gain or BIH in a patient on protease inhibitors.
Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Pseudotumor Cerebral/induzido quimicamente , Aumento de Peso/efeitos dos fármacos , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Adulto , Feminino , Humanos , Pseudotumor Cerebral/diagnósticoRESUMO
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.