Pseudotumor cerebral sem edema de papila óptica

Seggia, J. C. Brant; Menezes, M. L. Bezerra de

doi:10.1590/S0004-282X1993000400015

Resumos

Os autores apresentam quatro casos de síndrome de hipertensão intracraniana benigna em duas mulheres e dois homens jovens e magros em que todos os critérios diagnósticos foram preenchidos exceto a presença de edema de papila óptica. Considerando que casos semelhantes já foram descritos por outros, pareceu-lhes justificada a proposição que fazem de não ser obrigatória a presença de edema de papila óptica para o diagnóstico da síndrome. Apresentam uma hipótese para explicar o fato e discutem outros detalhes dos casos.

pseudotumor cerebral; hipertensão intracraniana benigna; papilas ópticas normais

Four cases of benign intracranial hypertension in two nonobese women (23 and 36 yr. old) and two nonobese men (both 47 yr. old) are presented. The most remarkable finding of the clinical investigation of these cases was the absence of papilledema. Our finding is consistent with other reports, and suggest that the presence of papilledema should not be considered critical for the diagnosis of benign intracranial hypertension. Additionally, the authors present a hypothesis for the absence of papilledema in cases otherwise typical of benign intracranial hypertension.

pseudotumor cerebri; benign intracranial hypertension; normal optic papillae

J. C. Brant Seggia^I; M. L. Bezerra de Menezes^II

^IChefe de Clínica do Serviço de Neurologia do Hospital dos Servidores do Estado/ INAMPS, Rio de Janeiro (HSE)

^IIMédico Residente do Serviço de Neurocirurgia do HSE

RESUMO

Os autores apresentam quatro casos de síndrome de hipertensão intracraniana benigna em duas mulheres e dois homens jovens e magros em que todos os critérios diagnósticos foram preenchidos exceto a presença de edema de papila óptica. Considerando que casos semelhantes já foram descritos por outros, pareceu-lhes justificada a proposição que fazem de não ser obrigatória a presença de edema de papila óptica para o diagnóstico da síndrome. Apresentam uma hipótese para explicar o fato e discutem outros detalhes dos casos.

Palavras-chave: pseudotumor cerebral, hipertensão intracraniana benigna, papilas ópticas normais.

SUMMARY

Four cases of benign intracranial hypertension in two nonobese women (23 and 36 yr. old) and two nonobese men (both 47 yr. old) are presented. The most remarkable finding of the clinical investigation of these cases was the absence of papilledema. Our finding is consistent with other reports, and suggest that the presence of papilledema should not be considered critical for the diagnosis of benign intracranial hypertension. Additionally, the authors present a hypothesis for the absence of papilledema in cases otherwise typical of benign intracranial hypertension.

Key words: pseudotumor cerebri, benign intracranial hypertension, normal optic papillae.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Aceite: 4-março-1993.

Dr. José Carlos Brant Seggia Av. Ary Parreiras 659 - 24230-321 Niterói RJ - Brasil.

1. Ahlskog JE, O'Neill BP. Pseudotumor cerebri. Ann Intern Med 1982, 97:249-256.
2. Arbit E, Ruff RL. A blind spot tester. J Neurol Neurosurg Psychiatry 1981, 44:93-99.
3. Arbit E, Ruff RL. A blind spot tester. J Neurol Neurosurg Psychiatry 1981, 44:92-93.
4. Ark GDV, Kempe LG, Smith DR. Pseudotumor cerebri treated with lumbar-peritoneal shunt. JAMA 1971, 217:1832-1834.
5. Bettman JW, Daroff BB, Sanders MD, Hoyt WF. Papilledema and asyntomatic intracranial hypertension in systemic lupus erythematosus. Arch Ophthalm 1968, 80:189.
6. Boreus LD, Sundstrom B. Intracrianl hypertension during treatment with nalidixic acid. Br Med J 1967, 2:744.
7. Bulens C, DeVries WAJ, van Crevel H. Benign intracranial hypertension: a retrospective and follow-up study. J Neurol Sci 1979, 40:147.
8. Capriles LF. Intracrainal hypertension and iron-deficiency anemia: report of four cases. Arch Neurol 1963, 9:147-153.
9. Conn GA. Pseudotumor cerebri in children secondary to administration of adrenal steroids. J Neurosurg 1963, 20:784-786.
10. Corbett JJ, Savino PJ, Thompson HS, Kansu T, Schatz NJ, Orr LS, Hopson D. Visual loss in pseudotumor cerebri: follow-up of 57 patients from 5 to 41 years and profile of 14 patients with permanent severe visual loss. Arch Neurol 1982, 39:461-474.
11. Dandy WE. Intracranial pressure without brain tumor. Am Surg 1937, 106:492-513.
12. Dees SC, MacKay HWJr. Occurence of pseudotumor cerebri during treatment of children with asthma by adrenal steroids. Pediatrics 1959, 23:1143-1151.
13. Friesen L, Holm M. Visual field defects associated with choroidal folds. In Glaser J (ed): Neuro-ophthalmology. Ed 9. St Louis: Mosby, 1973, p 248-253.
14. Goley KM, Posner JB. Does pseudotumor cerebri cause the empty sella syndrome? Neurology 1975, 25:565-569.
15. Greer M. Benign intracranial hypertension: II. Following corticosteroid therapy. Neurology 1963, 13:439-441.
16. Greer M. Benign intracranial hypertension: III. Pregnancy. Neurology 1963, 13:670-672.
17. Greer M. Benign intracranial hypertension: IV Menarche. Neurology 1964, 14:569-573.
18. Greer M. Benign intracranial hypertension: V. Menstrual dysfunction. Neurology 1964, 14:668-673.
19. Greer M. Benign intracranial hypertension: VI. Obesity. Neurology 1965, 15:382-388. Hayreh SS. Pathogenesis of oedema of the optic disc (papilledema). Br J Opthtalm 1964, 48:522-543.
20. Hoyt WF, Pont ME. Pseudopapilledema: anomalous elevation of optic disk. Pitfalls in diagnosis and management. JAMA 1962, 181:191-196.
21. Huckman MS, Fox JS, Ramsey RG, Penn RD. Computed tomography in the diagnosis of pseudotumor cerebri. Radiology 1976, 119:593-597.
22. Huckman MS, Fox JS, Ramsey RG, Penn RD. Computed tomography in the diagnosis of pseudotumor cerebri. Radiology 1976, 119:593-597.
23. Jackson I, Snodgrass SR. Peritoneal shunt in the treatment of hydrocephalus and increased intracranial pressure. J Neurosurg 1955, 12:216-222.
24. Jefferson A, Clark J. Treatment of benign intracranial hypertension by dehydrating agents with particular reference to the measurement of improvement. J Neurol Neurosurg Psychiatry 1976, 39:627-639.
26. Jefferson A. A clinical correlation between encephalopathy and papilledema in Addison's disease. J Neurol Neurosurg Psychiatry 1956, 19:2-27.
27. Johnston I, Hawke S, Halmagyi M, Teo C. The pseudotumor syndrome: disorders of cerebrospinal fluid circulation causing intracranial hypertension without ventriculomegaly. Arch Neurol 1991, 48:740-747.
28. Katz B, van Patten P, Rothrock JR, Katzman R. Optic nerve head drusen and pseudotumor cerebri. Arch Neurol 1968, 45:7.
29. Kilpatrick CJ. Optic nerve decompression in benign intracranial hypertension. Clin Exp Neurol 1981, 18:161.
30. Koch-Weser J, Gilmore EB. Benign intracranial hypertension in an adult after tetracycline therapy. JAMA 1967, 200:345-347.
31. Lipton HL, Michelson PE. Pseudotumor cerebri syndrome without papilledema. JAMA 1972, 220:1591-1592.
32. Lubcek MJ. Papilledema caused by iron-deficiency anemia. Trans Am Acad Ophthalm 1959, 63:306-310.
33. Marcelis J, Silberstein SD. Idiopathic intracranial hypertension without papilledema. Arch Neurol 1991, 48:392-399.
34. Marr WG, Chambers RG. Pseudotumor cerebri syndrome following unilateral radical neck dissection. Am J Ophthalm 1961, 51:604-611.
35. McCullagh BP. Menstrual edema with intracranial hypertension (pseudotumor cerebri) : report of a case. Cleveland Clin Quart 1941, 8:202-212.
36. Meyer JS, Gotham J, Tazaki Y, Gotoh F. Cardiorespiratory syndrome of extreme obesity with papilledema. Neurology 1961, 11:950-958.
37. Miller SJH, Sanders MD, Fytche TJ. Fluorescein fundus photography in the detection of early papilloedema and its differentiation from pseudo-papilloedema. Lancet 1965, 2:651-654.
38. Morrice J r G, Havener WH, Kapetansky F. Vitamin A a cause of pseudotumor cerebri. JAMA 1960, 173:1802-1805.
39. O'Doherty NJ. Acute benign intracranial hypertension in an infant receiving tetracycline. Develop Med Child Neurol 1965, 7:677-680.
40. Repka MX, Miller NR. Pseudotumor cerebri. Am J Ophthalm 1984, 98:741-746.
41. Rosemberg MA, Savino PJ, Glaser JS. A clinical analysis of pseudopapilledema: I. Population, laterality, acuity, refrative error, ophthalmoscopic characteristics and coincident disease. Arch Ophthalm 1979, 97:65-70.
42. Scanarini M, Mingrino S, Davella D, Delia Corte V. Benign intracranial hypertension without papilledema: case report. Neurosurgery 1979, 5:376-377.
43. Sorensen PS, Krogsaa B, Gjerris F. Clinical course and prognosis of pseudotumor cerebri: a prospective study of 24 patients. Acta Neurol Scand 1988, 77:164-172.
44. Spence JD, Amacher AL, Willis NR. Benign intracranial hypertension without papilledema: role of 24-hour cerebrospinal fluid pressure monitoring in diagnosis and management. Neurosurgery 1980, 7:326-336.
45. Sullivan HC. Fatal tonsillar herniation in pseudotumor cerebri. Neurology 1991, 41: 1142-1144.
46. Troost BT, Sufit RL, Grand G. Sudden monocular visual loss in pseudotumor cerebri. Arch Neurol 1979, 36:440-442.
47. Tulanne WM. Idiopathic intracranial hypertension: a prospective study of 50 patients. Brain 1991, 114:155-180.
48. Tullane WM. The headache profile of idiopathic intracranial hypertension. Cephalalgia 1990, 10:331-335.
49. Van der Ark GD, Kempe LG, Smith DR. Pseudotumor cerebri treated with lumbar-peritoneal shunt. JAMA 1971, 217:1832-1834.
50. Vassilouthis J, Uttley D. Benign intracranial hypertension: clinical features and diagnosis using computed tomopraphy and treatment. Surg Neurol 1979, 12:389.
51. Walker AE, Adamkiewicz JJ. Pseudotumor cerebri associated with prolonged corticosteroid therapy. JAMA 1964, 188:779-784.
52. Walsh FB, Hoyt WF. Clinical neuro-ophthalmology. Ed 3. Baltimore: William and Wilkins, 1974, Vol 3, p 1938-1939.
53. Walsh FB. Papilledema associated with increased intracranial pressure in Addison's disease. Arch Ophthalm 1952, 47:86.
54. Wash FR, Hoyt M. Clinical neuro-ophthalmology. Baltimore: William and Wilkins, 1969, Vol 1, p 65.
55. Weisberg LA. Benign intracranial hypertension. Medicine 1975, 54:197-207.

Pseudotumor cerebral sem edema de papila óptica

Pseudotumor cerebri in the absence of papilledema

Datas de Publicação

Publicação nesta coleção
19 Jan 2011
Data do Fascículo
Nov 1993

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Ahlskog JE, O'Neill BP. Pseudotumor cerebri. Ann Intern Med 1982, 97:249-256.

[2] 2. Arbit E, Ruff RL. A blind spot tester. J Neurol Neurosurg Psychiatry 1981, 44:93-99.

[3] 3. Arbit E, Ruff RL. A blind spot tester. J Neurol Neurosurg Psychiatry 1981, 44:92-93.

[4] 4. Ark GDV, Kempe LG, Smith DR. Pseudotumor cerebri treated with lumbar-peritoneal shunt. JAMA 1971, 217:1832-1834.

[5] 5. Bettman JW, Daroff BB, Sanders MD, Hoyt WF. Papilledema and asyntomatic intracranial hypertension in systemic lupus erythematosus. Arch Ophthalm 1968, 80:189.

[6] 6. Boreus LD, Sundstrom B. Intracrianl hypertension during treatment with nalidixic acid. Br Med J 1967, 2:744.

[7] 7. Bulens C, DeVries WAJ, van Crevel H. Benign intracranial hypertension: a retrospective and follow-up study. J Neurol Sci 1979, 40:147.

[8] 8. Capriles LF. Intracrainal hypertension and iron-deficiency anemia: report of four cases. Arch Neurol 1963, 9:147-153.

[9] 9. Conn GA. Pseudotumor cerebri in children secondary to administration of adrenal steroids. J Neurosurg 1963, 20:784-786.

[10] 10. Corbett JJ, Savino PJ, Thompson HS, Kansu T, Schatz NJ, Orr LS, Hopson D. Visual loss in pseudotumor cerebri: follow-up of 57 patients from 5 to 41 years and profile of 14 patients with permanent severe visual loss. Arch Neurol 1982, 39:461-474.

[11] 11. Dandy WE. Intracranial pressure without brain tumor. Am Surg 1937, 106:492-513.

[12] 12. Dees SC, MacKay HWJr. Occurence of pseudotumor cerebri during treatment of children with asthma by adrenal steroids. Pediatrics 1959, 23:1143-1151.

[13] 13. Friesen L, Holm M. Visual field defects associated with choroidal folds. In Glaser J (ed): Neuro-ophthalmology. Ed 9. St Louis: Mosby, 1973, p 248-253.

[14] 14. Goley KM, Posner JB. Does pseudotumor cerebri cause the empty sella syndrome? Neurology 1975, 25:565-569.

[15] 15. Greer M. Benign intracranial hypertension: II. Following corticosteroid therapy. Neurology 1963, 13:439-441.

[16] 16. Greer M. Benign intracranial hypertension: III. Pregnancy. Neurology 1963, 13:670-672.

[17] 17. Greer M. Benign intracranial hypertension: IV Menarche. Neurology 1964, 14:569-573.

[18] 18. Greer M. Benign intracranial hypertension: V. Menstrual dysfunction. Neurology 1964, 14:668-673.

[19] 19. Greer M. Benign intracranial hypertension: VI. Obesity. Neurology 1965, 15:382-388. Hayreh SS. Pathogenesis of oedema of the optic disc (papilledema). Br J Opthtalm 1964, 48:522-543.

[20] 20. Hoyt WF, Pont ME. Pseudopapilledema: anomalous elevation of optic disk. Pitfalls in diagnosis and management. JAMA 1962, 181:191-196.

[21] 21. Huckman MS, Fox JS, Ramsey RG, Penn RD. Computed tomography in the diagnosis of pseudotumor cerebri. Radiology 1976, 119:593-597.

[22] 22. Huckman MS, Fox JS, Ramsey RG, Penn RD. Computed tomography in the diagnosis of pseudotumor cerebri. Radiology 1976, 119:593-597.

[23] 23. Jackson I, Snodgrass SR. Peritoneal shunt in the treatment of hydrocephalus and increased intracranial pressure. J Neurosurg 1955, 12:216-222.

[24] 24. Jefferson A, Clark J. Treatment of benign intracranial hypertension by dehydrating agents with particular reference to the measurement of improvement. J Neurol Neurosurg Psychiatry 1976, 39:627-639.

[25] 26. Jefferson A. A clinical correlation between encephalopathy and papilledema in Addison's disease. J Neurol Neurosurg Psychiatry 1956, 19:2-27.

[26] 27. Johnston I, Hawke S, Halmagyi M, Teo C. The pseudotumor syndrome: disorders of cerebrospinal fluid circulation causing intracranial hypertension without ventriculomegaly. Arch Neurol 1991, 48:740-747.

[27] 28. Katz B, van Patten P, Rothrock JR, Katzman R. Optic nerve head drusen and pseudotumor cerebri. Arch Neurol 1968, 45:7.

[28] 29. Kilpatrick CJ. Optic nerve decompression in benign intracranial hypertension. Clin Exp Neurol 1981, 18:161.

[29] 30. Koch-Weser J, Gilmore EB. Benign intracranial hypertension in an adult after tetracycline therapy. JAMA 1967, 200:345-347.

[30] 31. Lipton HL, Michelson PE. Pseudotumor cerebri syndrome without papilledema. JAMA 1972, 220:1591-1592.

[31] 32. Lubcek MJ. Papilledema caused by iron-deficiency anemia. Trans Am Acad Ophthalm 1959, 63:306-310.

[32] 33. Marcelis J, Silberstein SD. Idiopathic intracranial hypertension without papilledema. Arch Neurol 1991, 48:392-399.

[33] 34. Marr WG, Chambers RG. Pseudotumor cerebri syndrome following unilateral radical neck dissection. Am J Ophthalm 1961, 51:604-611.

[34] 35. McCullagh BP. Menstrual edema with intracranial hypertension (pseudotumor cerebri) : report of a case. Cleveland Clin Quart 1941, 8:202-212.

[35] 36. Meyer JS, Gotham J, Tazaki Y, Gotoh F. Cardiorespiratory syndrome of extreme obesity with papilledema. Neurology 1961, 11:950-958.

[36] 37. Miller SJH, Sanders MD, Fytche TJ. Fluorescein fundus photography in the detection of early papilloedema and its differentiation from pseudo-papilloedema. Lancet 1965, 2:651-654.

[37] 38. Morrice J r G, Havener WH, Kapetansky F. Vitamin A a cause of pseudotumor cerebri. JAMA 1960, 173:1802-1805.

[38] 39. O'Doherty NJ. Acute benign intracranial hypertension in an infant receiving tetracycline. Develop Med Child Neurol 1965, 7:677-680.

[39] 40. Repka MX, Miller NR. Pseudotumor cerebri. Am J Ophthalm 1984, 98:741-746.

[40] 41. Rosemberg MA, Savino PJ, Glaser JS. A clinical analysis of pseudopapilledema: I. Population, laterality, acuity, refrative error, ophthalmoscopic characteristics and coincident disease. Arch Ophthalm 1979, 97:65-70.

[41] 42. Scanarini M, Mingrino S, Davella D, Delia Corte V. Benign intracranial hypertension without papilledema: case report. Neurosurgery 1979, 5:376-377.

[42] 43. Sorensen PS, Krogsaa B, Gjerris F. Clinical course and prognosis of pseudotumor cerebri: a prospective study of 24 patients. Acta Neurol Scand 1988, 77:164-172.

[43] 44. Spence JD, Amacher AL, Willis NR. Benign intracranial hypertension without papilledema: role of 24-hour cerebrospinal fluid pressure monitoring in diagnosis and management. Neurosurgery 1980, 7:326-336.

[44] 45. Sullivan HC. Fatal tonsillar herniation in pseudotumor cerebri. Neurology 1991, 41: 1142-1144.

[45] 46. Troost BT, Sufit RL, Grand G. Sudden monocular visual loss in pseudotumor cerebri. Arch Neurol 1979, 36:440-442.

[46] 47. Tulanne WM. Idiopathic intracranial hypertension: a prospective study of 50 patients. Brain 1991, 114:155-180.

[47] 48. Tullane WM. The headache profile of idiopathic intracranial hypertension. Cephalalgia 1990, 10:331-335.

[48] 49. Van der Ark GD, Kempe LG, Smith DR. Pseudotumor cerebri treated with lumbar-peritoneal shunt. JAMA 1971, 217:1832-1834.

[49] 50. Vassilouthis J, Uttley D. Benign intracranial hypertension: clinical features and diagnosis using computed tomopraphy and treatment. Surg Neurol 1979, 12:389.

[50] 51. Walker AE, Adamkiewicz JJ. Pseudotumor cerebri associated with prolonged corticosteroid therapy. JAMA 1964, 188:779-784.

[51] 52. Walsh FB, Hoyt WF. Clinical neuro-ophthalmology. Ed 3. Baltimore: William and Wilkins, 1974, Vol 3, p 1938-1939.

[52] 53. Walsh FB. Papilledema associated with increased intracranial pressure in Addison's disease. Arch Ophthalm 1952, 47:86.

[53] 54. Wash FR, Hoyt M. Clinical neuro-ophthalmology. Baltimore: William and Wilkins, 1969, Vol 1, p 65.

[54] 55. Weisberg LA. Benign intracranial hypertension. Medicine 1975, 54:197-207.