New Onset Severe Anemia and Fulminant Idiopathic Intracranial Hypertension

• Published in: Canadian journal of neurological sciences Vol. 49; no. 5; pp. 713 - 715
• Main Authors: Waisberg, Ethan, Yu, Caberry W., Sverdlichenko, Irina, Micieli, Jonathan A.
• Format: Journal Article
• Language: English
• Published: New York, USA Cambridge University Press 01.09.2022
• Subjects: Abortion; Anemia; Biopsy; Body mass index; Diplopia; Edema; Fibroids; Headaches; Hemoglobin; Hypertension; Iron; Letters to the Editor: Published Article; Neck pain; Sinuses; Tinnitus; Visual acuity; Anemia; Pseudotumor cerebri syndrome; Idiopathic intracranial hypertension
• ISSN: 0317-1671; 2057-0155
• DOI: 10.1017/cjn.2021.203

Details of five patients with anemia and fulminant idiopathic intracranial hypertension Characteristic Case 1 Case 2 Case 3 Case 4 Case 5 Sex Female Female Female Female Female Ethnicity Native Canadian South Asian Middle East South Asian South Asian Age at diagnosis, years 26 28 18 40 29 BMI at diagnosis, kg/m2 34.2 25.0 30.2 39.5 26.0 Presenting symptoms Headache, neck pain, PT Headache, neck pain, PT Headache, diplopia Headache, neck pain Headache, PT Presenting hemoglobin, g/L 76 63 78 67 63 Presenting MCV 67.2 75.5 76.1 69.0 48.0 Platelets, 109/L 516 343 344 407 401 Creatinine, µmol/L 58 54 52 59 54 Anemia etiology Iron deficiency, fibroids Medical abortion Iron deficiency B12 deficiency Iron deficiency, fibroids Iron deficiency Initial examination Visual acuity OD; OS 20/50; 20/50 20/30; 20/20 20/20; 20/20 20/25; 20/30 20/40; 20/80 Humphrey mean deviation OD; OS, dB −10.89; −11.34 −6.84; −5.34 −3.73; −5.48 −6.34; −7.02 −11.48; −10.4 IIH diagnostic testing Opening pressure, cm H2O >55 >55 >55 >55 49 Magnetic resonance imaging result Flattening of posterior sclera Partially empty sella, flattening of posterior sclera Flattening of posterior sclera Partially empty sella, flattening of posterior sclera Partially empty sella, flattening of posterior sclera Magnetic resonance venography result Distal transverse sinus stenosis Distal transverse sinus stenosis Distal transverse sinus stenosis Distal transverse sinus stenosis Distal transverse sinus stenosis Pharmacologic treatment Maximum acetazolamide dose, g 4 2 1.5 4 3 Surgical treatment ONSF OD None None None None Hemoglobin at final follow-up, g/L 126 121 121 119 115 Final examination Visual acuity OD; OS 20/25; 20/20 20/25; 20/20 20/20; 20/20 20/20; 20/25 20/20; 20/20 Humphrey mean deviation OD; OS, dB −6.8; −7.02 −6.59; −4.89 0.58; −1.97 −1.48; −2.67 −1.82; −2.75 BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); cmH2O, centimeters of water; dB, decibels. The relationship between anemia and IIH remains controversial.3 Our group performed a systematic review of the literature and identified 74 cases of IIH reported in the literature that were associated with anemia, with only 16 of these patients reported to be obese.4 The most common causes of anemia were iron deficiency. In 60% of cases, anemia treatment without ICP-lowering therapy was initiated and patients demonstrated improvement or resolution of symptoms. [...]15 patients only treated for anemia had repeated LP after treatment and there was a reduction of ICP by 13.5 cmH2O at a mean follow-up of 2.5 months.