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Graves' disease presenting as pseudotumor cerebri: a case report.

Coutinho E, Silva AM, Freitas C, Santos E - J Med Case Rep (2011)

Bottom Line: Common secondary causes include endocrine pathologies.Hyperthyroidism is very rarely associated and only three case reports have been published so far.We report the case of a 31-year-old Luso-African woman with clinical symptoms and laboratory confirmation of Graves' disease that presented as pseudotumor cerebri.

View Article: PubMed Central - HTML - PubMed

Affiliation: Serviço de Neurologia, Hospital Santo António, Largo Professor Abel Salazar, 4099-001 Porto, Portugal. estercoutinho@gmail.com.

ABSTRACT

Introduction: Pseudotumor cerebri is an entity characterized by elevated intracranial pressure with normal cerebrospinal fluid and no structural abnormalities detected on brain MRI scans. Common secondary causes include endocrine pathologies. Hyperthyroidism is very rarely associated and only three case reports have been published so far.

Case presentation: We report the case of a 31-year-old Luso-African woman with clinical symptoms and laboratory confirmation of Graves' disease that presented as pseudotumor cerebri.

Conclusion: This is a rare form of presentation of Graves' disease and a rare cause of pseudotumor cerebri. It should be remembered that hyperthyroidism is a potential cause of pseudotumor cerebri.

No MeSH data available.


Related in: MedlinePlus

Brain MRI scan with venography. A brain MRI scan showing normal morphology, ventricular dimensions and venous drainage.
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Figure 1: Brain MRI scan with venography. A brain MRI scan showing normal morphology, ventricular dimensions and venous drainage.

Mentions: A 31-year-old Luso-African woman who was a law student was admitted to our department. She was slim (body mass index (BMI) of 22), with no relevant medical history and not taking any drugs. She presented with progressive symptoms: persistent headache and vomiting that had lasted for six months accompanied by visual disturbance ('blurred vision') in the last few days. She also stated she had pain with ocular movements and neck stiffness. She had also shown clinical symptoms and signs (tremor, diarrhea, tachycardia, heat intolerance and exophthalmus) for the past five months suggestive of hyperthyroidism. On neurological examination she presented with bilateral papilledema and nuchal rigidity. Goldmann visual fields showed bilateral enlargement of the blind spot. Results of a brain MRI with venography were normal (Figure 1). Her CSF opening pressure was raised (410 mm of water), had no cells, with normal glucose and protein levels. A lumbar puncture to relieve pressure was not performed; the diagnostic lumbar puncture caused no symptomatic relief. Blood analysis showed a totally suppressed thyroid-stimulating hormone level of 0.01 mIU/L (normal 0.35 to 4.50 mIU/L) and a free T3 level of 31.6 pmol/L (normal 3.5 to 6.5 pmol/L). A thyroid-stimulating hormone receptor antibody value of 49 U/L and thyroid scintigraphy showing a diffusely increased radiotracer uptake goiter (Figure 2) confirmed the diagnosis of Graves' disease. Other etiological causes were excluded via blood and CSF analysis, namely infectious and immunological diseases. Pharmacological causes were excluded since she was not taking any drugs. Treatment with tiamazol (30 mg/day), propranolol (120 mg/day) and acetazolamide (1500 mg/day) was given. After 10 days of treatment she had no headaches, nausea or vomiting. The papilledema resolved in the following months. She continued acetazolamide treatment for four months and is currently being treated with tiamazol. Her thyroid function slowly recovered.


Graves' disease presenting as pseudotumor cerebri: a case report.

Coutinho E, Silva AM, Freitas C, Santos E - J Med Case Rep (2011)

Brain MRI scan with venography. A brain MRI scan showing normal morphology, ventricular dimensions and venous drainage.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3049746&req=5

Figure 1: Brain MRI scan with venography. A brain MRI scan showing normal morphology, ventricular dimensions and venous drainage.
Mentions: A 31-year-old Luso-African woman who was a law student was admitted to our department. She was slim (body mass index (BMI) of 22), with no relevant medical history and not taking any drugs. She presented with progressive symptoms: persistent headache and vomiting that had lasted for six months accompanied by visual disturbance ('blurred vision') in the last few days. She also stated she had pain with ocular movements and neck stiffness. She had also shown clinical symptoms and signs (tremor, diarrhea, tachycardia, heat intolerance and exophthalmus) for the past five months suggestive of hyperthyroidism. On neurological examination she presented with bilateral papilledema and nuchal rigidity. Goldmann visual fields showed bilateral enlargement of the blind spot. Results of a brain MRI with venography were normal (Figure 1). Her CSF opening pressure was raised (410 mm of water), had no cells, with normal glucose and protein levels. A lumbar puncture to relieve pressure was not performed; the diagnostic lumbar puncture caused no symptomatic relief. Blood analysis showed a totally suppressed thyroid-stimulating hormone level of 0.01 mIU/L (normal 0.35 to 4.50 mIU/L) and a free T3 level of 31.6 pmol/L (normal 3.5 to 6.5 pmol/L). A thyroid-stimulating hormone receptor antibody value of 49 U/L and thyroid scintigraphy showing a diffusely increased radiotracer uptake goiter (Figure 2) confirmed the diagnosis of Graves' disease. Other etiological causes were excluded via blood and CSF analysis, namely infectious and immunological diseases. Pharmacological causes were excluded since she was not taking any drugs. Treatment with tiamazol (30 mg/day), propranolol (120 mg/day) and acetazolamide (1500 mg/day) was given. After 10 days of treatment she had no headaches, nausea or vomiting. The papilledema resolved in the following months. She continued acetazolamide treatment for four months and is currently being treated with tiamazol. Her thyroid function slowly recovered.

Bottom Line: Common secondary causes include endocrine pathologies.Hyperthyroidism is very rarely associated and only three case reports have been published so far.We report the case of a 31-year-old Luso-African woman with clinical symptoms and laboratory confirmation of Graves' disease that presented as pseudotumor cerebri.

View Article: PubMed Central - HTML - PubMed

Affiliation: Serviço de Neurologia, Hospital Santo António, Largo Professor Abel Salazar, 4099-001 Porto, Portugal. estercoutinho@gmail.com.

ABSTRACT

Introduction: Pseudotumor cerebri is an entity characterized by elevated intracranial pressure with normal cerebrospinal fluid and no structural abnormalities detected on brain MRI scans. Common secondary causes include endocrine pathologies. Hyperthyroidism is very rarely associated and only three case reports have been published so far.

Case presentation: We report the case of a 31-year-old Luso-African woman with clinical symptoms and laboratory confirmation of Graves' disease that presented as pseudotumor cerebri.

Conclusion: This is a rare form of presentation of Graves' disease and a rare cause of pseudotumor cerebri. It should be remembered that hyperthyroidism is a potential cause of pseudotumor cerebri.

No MeSH data available.


Related in: MedlinePlus