J of IMAB 2012; 18(1):206-208
IDIOPATHIC INTRACRANIAL HYPERTENSION IN A WOMAN WITH SCHIZOPHRENIA
Alexandra J. Tzoukeva, Nadezhda S. Deleva, Ara G. Kaprelyan, Ivan N. Dimitrov
First Clinic of Neurology, University "Sveta Marina" Hospital, Varna, Medical University - Varna, Bulgaria

ABSTRACT:
Idiopathic intracranial hypertension (IIH) or benign intracranial hypertension is a neurological syndrome characterized by elevated intracranial pressure. This uncommon disorder occurs primarily in obese women aged 10 to 50 years, sometimes in association with endocrine and metabolic dysfunction, with systemic diseases or when treated with multiple medications.
We describe a case of IIH in a 43-year-old woman with schizophrenia treated with risperidone, demonstrating a typical clinical picture of benign intracranial hypertension. For the 5 years of treatment with risperidone she put on 35 kg in total (BMI> 35); for the last 2-3 months she began to complain of visual obscurations, nausea with vomiting. Ophthalmoscopy revealed bilateral asymmetric papilledema (OD>OS). Magnetic resonance imaging was normal, intracranial pressure was elevated IIH was diagnosed. Risperidone was discontinued and replaced with Seroquel 200 mg daily. Treatment with furosemide and mannitol 10 % was initiated. Papilledema resolved completely over the next 2 months. The patient was followed-up for four years after risperidone withdrawal. Weight loss of 28 kg was noted for four years. There were no relapses of headache, nausea, visual obscuration. Ophthalmologic examination revealed no papilledema.
We suggest that prolonged use of antipsychotics, such as risperidone, should require proper surveillance for possible development of IIH and routine ophthalmologic examinations should be performed.

Key words: Idiopathic intracranial hypertension, Benign intracranial hypertension, Risperidone, Weight gain, Schizophrenia.

- Download FULL TEXT (PDF 576 KB)
Please cite this article as: Tzoukeva AJ, Deleva NS, Kaprelyan AG, Dimitrov IN. IDIOPATHIC INTRACRANIAL HYPERTENSION IN A WOMAN WITH SCHIZOPHRENIA. J of IMAB. 2012; 18(1):206-208. doi: 10.5272/jimab.2012181.206.

REFERENCES:
1. Acheson JF. Idiopathic intracranial hypertension and visual function. Br. Med. Bull., 2006; 79-80(1):233-234. Epub 2007 Jan 22. [PubMed] [CrossRef]
2. Akgün C., Taşkin GA, Akbayram S., Kaya A., Tëmel H., Yuca SA, Caksen H. A case of idiopathic intracranial hypertension related with vesicoureteral reflux. Hiroshima J Med Sci. 2011 Sep;60(3):67-69. [PubMed]
3. Dhungana S., Sharrack B., Woodroofe N. Idiopathic intracranial hypertension. Acta Neurol Scand. 2010 Feb;121(2):71-82. Epub 2009 Nov 23. [PubMed] [CrossRef]
4. Eberhard J, Lindstr E, Holstad M. Levander S. Prolactin level during 5 years of risperidone treatment in patients with psychotic disorders. Acta Psychiatr Scand. 2007 Apr;115(4):268-76. [PubMed] [CrossRef]
5. Errguig L, Benomar A, Aitbenhaddou E, Mouti O, Regragui W, Benaaboud B, et all. Clinical and therapeutic aspects of benign intracranial hypertension. Rev. Neurol. (Paris). 2004 Dec;160(12):1187-1190. (Article in French) [PubMed]
6. Fiebai B., Chukwuka I. Presumed idiopathic intracranial hypertension: A case report and literature review. Niger J Med. 2011 Apr-Jun;20(2):289-291. [PubMed]
7. Friedman D. Papilledema. In: Miller N., Newman N., Biousse V., Kerrison J., eds. Walsh and Hoyt’s Clinical neuroophthalmology, 6th ed., Philadelphia, Lippincott Williams & Wilkins, 2004 (3):237-291.
8. Hannerz J., Ericson K. The relationship between idiopathic intracranial hypertension and obesity. Headache. 2009 Feb;49(2):178-184. [PubMed] [CrossRef]
9. Kesler A., Goldhammer Y., Hadayer A., Pianka P. The outcome of pseudotumor cerebri induced by tetracycline therapy. Acta Neurol. Scand. 2004 Dec;110(6):408-411. [PubMed] [CrossRef]
10. Ko  M., Chang S., Ridha  M., Ney J., Ali T., Friedman D, et all. Weight gain and recurence in idiopathic intracranial hypertension. Neurology. 2011 May 3; 76(18):1564-1567. [PubMed]
11. Levine SH, Puchalski C. Pseudotumor cerebri associated with lithium therapy in two patients. J. Clin. Psychiatry. 1990 Jun;51(6):251-253. [PubMed]
12. Meyer JM. A retrospective comparison of weight, lipid, and glucose changes between risperidone- and olanzapine-treated inpatients: metabolic outcomes after 1 year. J Clin Psychiatry. 2002 May;63(5):425-433. [PubMed]
13. Saul RF, Hamburger HA, Selhorst JB. Pseudotumor cerebri secondary to lithium carbonate, JAMA, 1985 May 17;253(19):2869-2870. [PubMed]
14. Serratrice J., Granel B., Conrath J., Dufour H., Disdier P., Henry JF, Weiller PJ. Benign intracranial hypertension and thyreostimulin suppression hormonotherapy. Am. J.  Ophthalmol. 2002 Dec; 134(6): 910-911. [PubMed]
15. Thambisetty M., Lavin PJ, Newman NJ, Biousse V. Fulminant idiopathic intracranial hypertension. Neurology, 2007 Jan 16;68(3):229-232. [PubMed]
16. Vischi A., Guerriero S., Giancipoli G., Lorusso V., Sborgia G. Delayed onset of pseudotumor cerebri syndrome 7 years after starting human recombinant growth hormone treatment. Eur. J. Ophthalmol. 1, 2006 Jan-Feb;16(1)178-180. [PubMed]
17. Wall M. Idiopathic intracranial hypertension (pseudotumor cerebri). Curr Neurol Neurosci Rep. 2008 Mar;8(2):87-93. [PubMed].

Accepted for publication: 08 December 2011
Issue published online: 07 February 2012

back to Online Journal