Abstract Details

Title A case of pediatric Idiopathic intracranial hypertension associated with aplastic anemia

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P13 - Poster Session 13 (8:00 AM-9:00 AM)

Poster/Presentation
Number 2-005

Background Papilledema is optic disc swelling secondary to raised intracranial pressure. Idiopathic intracranial hypertension (IIH) is a disorder of elevated intracranial pressure with unknown cause. Patients present with transient visual obscuration, pulsatile synchronous tinnitus, headache, papilledema, and diplopia. Conditions usually associated with IIH are obesity, hypervitaminosis A, steroid withdrawal, female gender. There have been only few cases of IIH reported with anemia.

Objective A unique case of idiopathic intracranial hypertension after the diagnosis of aplastic anemia.

Design/Methods A case report.

Results 11-year-old obese boy presented with 3-week history of intermittent blurry vision, headache and transient visual obscurations. He had visual acuity of 20/200 and grade IV papilledema bilaterally. MRI/MRV with features of IIH. LP with opening pressure of >55 cm H2O. He was started on Acetazolamide and prednisone. VP shunt was placed and Diamox was discontinued. He was found to have idiopathic hepatitis for which he was prescribed high doses of Vitamin A 4 months before his ocular symptoms. Later, he was diagnosed with aplastic anemia. He was also started on Promacta, a relatively new drug for anemia.

Conclusions

Acquired aplastic anemia is a rare pediatric disorder affecting 2-4 children per million each year and IIH is a rare complication of acquired aplastic anemia. Very few case of pediatric IIH have been reported with acquired aplastic anemia and its pathophysiology is not entirely clear. It was suggested that increased production of CSF could be the underlying mechanism. Acetazolamide has been used for IIH and according to one study 11 cases of acetazolamide induced aplastic anemia have been reported over a 17-year period. It is also possible that IIH could also be related to the initiation of Promacta.

This case emphasizes the significance of IIH in a pediatric patient with acquired aplastic anemia. Any patient with newly diagnosed acquired aplastic anemia will require careful ophthalmologic examination.

Authors/Disclosures
Usama Tariq, MD PRESENTER	Dr. Tariq has nothing to disclose.
	No disclosure on file
Rosario Maria S. Riel-Romero, MD, FAAN (Louisiana State University School of Medicine in Shreveport)	Dr. Riel-Romero has stock in Biointech. Dr. Riel-Romero has stock in Intuitive Surgical. Dr. Riel-Romero has stock in CRISPR. Dr. Riel-Romero has received personal compensation in the range of $100,000-$499,999 for serving as a Professor with LSU. An immediate family member of Dr. Riel-Romero has received personal compensation in the range of $100,000-$499,999 for serving as a Surgeon with VA.