Indian Journal of Ophthalmology

CASE REPORT
Year
: 1992  |  Volume : 40  |  Issue : 4  |  Page : 117-

Eltroxin induced pseudotumour cerebri-A case report


Madhumati Misra, GM Khan, Sanatan Rath 
 Department of Ophthalmology, SCB Medical College, Cuttack- 753007, India

Correspondence Address:
Madhumati Misra
Department of Ophthalmology, SCB Medical College, Cuttack- 753007
India




How to cite this article:
Misra M, Khan G M, Rath S. Eltroxin induced pseudotumour cerebri-A case report.Indian J Ophthalmol 1992;40:117-117


How to cite this URL:
Misra M, Khan G M, Rath S. Eltroxin induced pseudotumour cerebri-A case report. Indian J Ophthalmol [serial online] 1992 [cited 2021 Dec 4 ];40:117-117
Available from: https://www.ijo.in/text.asp?1992/40/4/117/24382


Full Text

 INTRODUCTION



The diagnosis of cerebral pseudotumour is established on findings as papilloedema without focal neurological deficit and with a battery of normal investigations as cerebrospinal fluid (CSF) analysis, electroen­cephalography (EEG), cerebral angiography and com­puted tomography (CT) with contrast enhancement [1][2][3][4][5]. The condition typically occures in obese females with endocrine and haematological disturbances, and a recent history of drug ingestion is often obtained [1][2][3][4]. However, it rarely results from thyroid disease (5). We report a rare case of pseudotumour cerebri developing after eltroxin therapy. The pitfalls in the diagnosis of pseudotumour cerebri is discussed with review of available literature.

 CASE REPORT



A female aged 30 years was seen in the neurooph­thalmic section of SCB Medical College, Cuttack for headache, vomiting and double vision of one month duration. The patient noted lethergy, cold intolerance, reduced appetite and amenorrhoea 6 months before and consulted a practitioner. Hypothyroid state was diagnosed based on diffuse thyroid swelling, mild anaemia and reduced T3, T4 levels in blood. Eltroxin therapy was instituted since 2 months.

Physical examination revealed no systemic or neurological deficit other than diffuse thyroid swelling and bilateral 6th nerve palsy. Funduscopy revealed bilateral gross papilloedema with preserved acuity and visual fields in both eyes. Routine laboratory tests were noncontributory. Conventional X-ray of skull, EEG, cerebral angiography did not help the diagnosis. CSF tap was avoided because of raised intracranial pressure (ICP). Cranial CT showed diffuse cerebral oedema with Ventricular compression without any mass lesion. Diagnosis of eltroxin induced pseu­dotumour cerebri was established. Eltroxin therapy was discontinued. Therapy for lowering ICP by mannitol infussion, oral glycerol and parenteral steroid was instituted. The symptoms of raised ICP, and bilateral 6th palsy disappeared within 15 days and regression of papilloedemawas noted. The patient is asymptomatic - till the day of last report.

 DISCUSSION



The association of pseudotumour cerebri with various metabolic and endocrine disorders has been well documented. Such causes include, (1) Menarche (2) hypoadrenalism (3) adrenal cortice steroid therapy, and particularly its withdrawal (4) hypopara thyroidsm; (5) vitamin A intoxication; (6) vitamin A deficiency; (7) drug toxicity (tetracycline, nalidixic acid, phenothiazines, and oral contraceptives); (8) iron deficiency anaemia; (9) intracranial venous sinus occlusion secondary to head injury, intracranial in­fection, and pregnancy [1][2][3][4][5].

Patients with pseudotumour cerebri complain of headache and vomiting in the absence of abnormal cerebro spinal fluid pattern. CT scan reveals narrowed and slit-like ventricles, indicating the presence of increased brain volume. Treatment consists of systemic corticosteroids, autazolamide, and restriction of salt consumption- If a causative factorcan be demonstrated, specific therapy must be instituted to protect vision. In the present case, psendotumour cerebri was induced by eltroxin therapy and could be reversed after withdrawal of the drug. the incidence is rare careful history taking it essential in patients who present this curious syndrome of pseudotumour cerebri.

References

1Johnson I and Paterson A - Benign intracranial hypertension, diagnosis and prognosis. Brain 97, 289-300, 1979.
2Weisberg LA and Nice C.N. - Computed tomographic evaluation of increased intracranial pressure. Radiology. 122. 133-136, 1977.
3Misra N. and Rath S - Papillo edema caused by spinal tumour in a case of optic nerve glioma. Ind. Jr. Ophthalmol. 32. 175-176, 1984.
4Misra M and Rath S - Multiple neuroflbroma of spinal cord presenting with papillo edema. Orissa Medical Journal (OMJ). 3. 27-28, 1984.
5Koul KL and Wangnoo SK - Pseudotumour cerebri with eitroxui therapy. Neurology India. 37. 551, 1989.