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Revista da Sociedade Brasileira de Medicina Tropical

Print version ISSN 0037-8682On-line version ISSN 1678-9849

Rev. Soc. Bras. Med. Trop. vol.53  Uberaba  2020  Epub June 08, 2020

https://doi.org/10.1590/0037-8682-0325-2020 

Images in Infectious Diseases

COVID-19 and benign intracranial hypertension: A case report

Fabio Noro1 
http://orcid.org/0000-0002-5193-5434

Fernando de Mendonça Cardoso2 

Edson Marchiori1 

1Universidade Federal do Rio de Janeiro, Departamento de Radiologia, Rio de Janeiro, RJ, Brasil

2Hospital Copa D’Or, Rede D’Or São Luiz, Serviço de Neurologia, Rio de Janeiro, RJ, Brasil.


A 35-year-old female patient, without comorbidities, presented to the emergency room with fever, dyspnea, and adynamia over the previous four days. She also had a complaint of a headache that had started two days before admission. She was lucid and oriented, without focal neurological deficits. During hospitalization, the headache worsened and she became disoriented. Fundoscopy was impaired. A cerebrospinal fluid puncture was performed, showing increased pressure (40 cm H2O). The cerebrospinal fluid analysis was entirely normal and negative for several pathogens. Real-time reverse-transcription polymerase chain reaction testing of a nasopharyngeal swab confirmed SARS-Cov-2 infection.

A brain magnetic resonance imaging scan showed signs of intracranial hypertension characterized by prominent subarachnoid space around optic nerves, vertical tortuosity of the optic nerves, and superior compression of the hypophysis (Figure 1A-C). Chest computed tomography showed round ground-glass opacities in both lungs (Figure 1D). The final diagnosis, based on clinical, laboratory, and imaging findings was benign intracranial hypertension (BIH).

FIGURE 1: (A and B) T2 axial and coronal magnetic resonance imaging scan shows prominent subarachnoid space around the optic nerves and their vertical tortuosity (arrows); (C) Coronal T2 magnetic resonance imaging scan of the selar region demonstrates compression of the upper portion of the pituitary gland by the selar diaphragm (arrow). (D) Chest computed tomography shows round peripheral ground-glass opacities in the right lung (arrow). 

The patient was treated with supportive measures and nasal oxygen. After two days of hospitalization, the patient returned to a normal level of consciousness and the headache disappeared. She was discharged asymptomatic two days later.

BIH (pseudotumor cerebri) is a clinical condition that includes headache, papilledema, increased blood pressure, and clear cerebrospinal fluid1. Multiple causes have been described for this condition, including venous sinus thrombosis, the toxicity of some substances such as vitamin A, tetracyclines and contraceptives, and sepsis1. To our knowledge, this is the first report of COVID-19 associated with isolated BIH.

ACKNOWLEDGMENTS

We offer our deepest thanks to the institutions that provided technical support for the development and implementation of this study.

REFERENCE

1. Corbett JJ. "Pseudotumor Cerebri" by any other name. Arch Ophthalmol. 2000;118(12):1685. [ Links ]

Received: May 26, 2020; Accepted: May 29, 2020

Corresponding author: Dr. Fabio Noro. e-mail:fncursos@gmail.com

Authors’ contribution: FN: Conception and design of the study, acquisition of data, drafting the article, final approval of the version to be submitted; EM: Conception and design of the study, drafting the article; FMC: Analysis and interpretation of data.

Conflict of Interest: The authors declare that there is no conflict of interest.

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License