Idiopathic Intracranial Hypertension in a Transgender Man

Abstract

We report a case of idiopathic intracranial hypertension (IIH) in a transgender man. To our knowledge, no such case has been described previously. A 33-year-old man presented to the neuro-ophthalmology clinic at the University of Florida in January 2007. He was complaining of headaches and blurred vision. IIH had been diagnosed 8 months earlier, and he was treated with 1,500 mg/day acetazolamide. He reported being a transgender woman-to-man who had undergone bilateral mastectomies and testosterone treatment that had been discontinued 18 months earlier. Our examination disclosed a patient who weighed 168 lbs with height of 5 feet 3 inches. Blood pressure was 118/72 mm Hg with a pulse of 84/min. Best-corrected visual acuities were 20/15 in each eye. Color vision was normal by Ishihara plate testing. Ophthalmoscopy showed optic disc edema in both eyes (Fig. 1). Humphrey visual fields showed nerve fiber bundle defects and enlarged blind spots in both eyes (Fig. 2). Results of a CT angiogram with attention to the venous phase was normal. A lumbar puncture disclosed an opening pressure of 300 mm H2O with normal constituents.FIG. 1: Optic disc edema is present in both eyes.FIG. 2: Humphrey visual fields show nasal defects and enlarged blind spots in both eyes.Because of side effects from acetazolamide, 80 mg/day furosemide was substituted for acetazolamide. For headache control, he was treated with 150 mg/day topiramate. On a follow-up 1 month later, visual field defects had improved. However, 2 months later, the visual field defects worsened, and he underwent an optic nerve fenestration in the right eye. One week postoperatively, visual field defects had improved in the left eye, but the right eye remained stable. On month later, visual field defects had improved in both eyes. IIH is found most commonly in overweight women in their reproductive years. It may also be caused by dural sinus thrombosis (5,6), a reduction in corticosteroid therapy, or hormonal imbalance (7-10), vitamin A, anabolic corticosteroids, tetracycline, lithium, and pregnancy (11-13). Our patient had prior use of testosterone. Despite the availability of transgender medicine for decades, we were unable to find a published report of IHH in patients who change gender. Clinton Sheets, MD Marc Peden, MD John Guy, MD Department of Ophthalmology University of Florida Gainesville, Florida [email protected]