Idiopathic intracranial hypertension secondary to iron‐deficiency anaemia

Abstract

AbstractPurposeTo present a case of idiopathic intracranial hypertension (IIH) in a 21‐year‐old female patient in whom iron‐deficiency anaemia was the primary risk factor.MethodsCase report and review of the scientific literature.ResultsA 21‐year‐old female presented to eye casualty with a 3‐day history of intermittent blurring of vision in both eyes. She denied any significant headache. Visual acuity was 6/6 in both eyes, colour vision was normal and there was no RAPD. However, dilated fundal examination revealed bilateral optic disc oedema. A CT scan of brain/orbits demonstrated a partially empty sella and mild vertical tortuosity of the optic nerves. A lumbar puncture was performed and the CSF opening pressure was elevated at 30cmH2O. These findings were consistent with a diagnosis of IIH. The patient lacked common risk factors for IIH: her body mass index was not elevated and she had not previously been prescribed tetracycline antibiotics, hormonal contraceptives or high‐dose vitamin A derivatives. However, she did have a history of excessive consumption of the oral analgesic Nurofen Plus (ibuprofen plus codeine). This had caused profound iron‐deficiency anaemia and her haemoglobin level two weeks prior to this presentation was 71 g/L. A review of the literature found three retrospective studies that examined the role of anaemia in IIH. While one study did not find any statistically significant associated between anaemia and IIH, two found that treating anaemia is associated with a faster recovery and better prognosis in patients with IIH. Correction of anaemia alone can lead to resolution of IIH.ConclusionsIdiopathic intracranial hypertension is a complex condition and the most important neurological manifestation is papilloedema, which may lead to progressive optic atrophy and visual loss. Anaemia appears to be a risk factor for IIH and a full blood count should be included in the routine investigation of these patients.