Intracranial hypertension due to spinal cord tumor misdiagnosed as pseudotumor cerebri syndrome: case report
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CASE REPORT
Open Access
Intracranial hypertension due to spinal cord tumor misdiagnosed as pseudotumor cerebri syndrome: case report Wanglu Hu, Chun Wang, Qun Wu, Yike Chen, Wei Gao, Guangyu Ying, Yongjian Zhu and Wei Yan*
Abstract Background: Isolated onset of intracranial hypertension due to spinal cord tumor is rare, thus, easily leading to misdiagnosis and delay in effective treatment. Case presentation: Herein, we describe a 45-year-old female patient who manifested isolated symptoms and signs of intracranial hypertension and whose condition was initially diagnosed as idiopathic intracranial hypertension and transverse sinus stenosis. The patient received a stent implantation; however, no improvements were observed. One year later her symptoms exacerbated, and during rehospitalization a spinal imaging examination revealed a lumbar tumor. Pathologic evaluation confirmed schwannoma, and tumor resection significantly improved her symptoms, except for poor vision. Conclusions: Space-occupying lesions of the spine should be considered in the differential diagnosis of idiopathic intracranial hypertension, even in the absence of spine-localized signs or symptoms. Keywords: Intracranial hypertension, Pseudotumor cerebri syndrome, Spinal tumor, Schwannoma, Venous sinus stenosis
Background Intracranial hypertension (ICH) secondary to spinal cord tumor is a relatively rare, but well-described manifestation. With a concomitant diagnostic ratio of 47% [1], its diagnosis is not particularly difficult when typical spinal symptoms or signs are present. However, absence of spinal cord signs could lead to misdiagnosis of idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri syndrome, which is defined as ICH with unknown etiology. Once misdiagnosed, a delay in treatment or unnecessary treatments can result in severe consequences for patients. We describe a patient who manifested isolated symptoms and signs of ICH. Her condition was initially * Correspondence: [email protected] Department of Neurosurgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou 310009, China
misdiagnosed as IIH and venous sinus stenosis. However, one year later a confirmed diagnosis of lumbar schwannoma was made. We also review the literature describing previous similar cases and share our views on associated pathophysiology and therapies.
Case presentation A 45-year-old female patient presented with blurred vision for 13 months and was initially diagnosed with papilledema at the ophthalmology department of another hospital. With no effective treatment, her condition deteriorated over the next 2 months. Consequently, she was admitted to the neurology department of our hospital. No other symptoms of ICH (headache, nausea, vomiting) or any other neurologic deficits were present on admission. The medium-build patient had no previous medical history or family history of venous thromboembolism or hematological diseases, and she
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