Settembre 2007 - Volume XXVI - numero 7
Pagine elettroniche ; Caso Contributivo
1Scuola di Specializzazione in Pediatria, Pavia;
2Istituto Clinico Humanitas, Rozzano (Milano)
Indirizzo per corrispondenza: cerpaola@libero.it
Key words: Pseudotumor cerebri, Diplopia, Exophthalmus,Thyroid pathology, Acetazolamide
The peculiarity of the present clinical case regarded a relatively benign pathology diagnosed by exclusion. It presented itself by an isolated symptom (diplopia) accompanied by a morphological characteristic (exophthalmus due to previous thyroid pathology), which led to confusion given that the two symptoms are usually not associated. The differential diagnosis included predominantly disorders of the neurosurgical field. The hypothetical diagnosis of pseudotumor cerebri with appropriate diuretic and dietetic therapies brought to complete and definite resolution of the clinical picture.
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Pagine elettroniche ; Caso Contributivo
1Servizio di Oculistica, IRCCS “Burlo Garofolo”, Trieste;
2Servizio di Endocrinologia e Diabetologia Pediatrica, IRCCS “Burlo Garofolo”, Trieste
Indirizzo per corrispondenza: marchetti@burlo.trieste.it
Key words: Idiopathic intracranial hypertension, rhGH, Acetazolamide, Corticosteroids
We report a case of idiopathic intracranial hypertension (IIH) (pseudotumor cerebri) following treatment with recombinant growth hormone (rhGH). A 9-year-old girl, treated for GH deficiency, developed bitemporal worsening headache, diplopia, intermittent exotropia and visual loss 3 months after starting rhGH. Ocular fundus examination revealed bilateral papilloedema and a MRI scan ruled out intracranial disease (including venous sinus thrombosis), leading to diagnosis of IIH. rhGH was discontinued and acetazolamide therapy was initiated up to 30 mg/kg/die dose without clinical improvement and with mild metabolic acidosis. We reduced acetazolamide to 20 mg/kg/die and added dexamethasone ev (0,4 mg/kg/die) with dramatic answer already after 1 day, then confirmed by fundus oculi and visual evocated potential. We suggest the use of corticosteroids in IIH when acetazolamide is inefficient or intolerable.
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