 |
Case Report
Medroxyprogesterone-induced idiopathic intracranial hypertension in a non-obese woman with a negative funduscopic examination
1 Intern, Internal Medicine Department, Hospital del Maestro, San Juan, Puerto Rico
2 PGY-III, Internal Medicine Department, San Juan City Hospital, San Juan, Puerto Rico
Address correspondence to:
Ivonne Hernández Castro
Calle Colorado Y 14 Parkville, Guaynabo-00969,
Puerto Rico
Message to Corresponding Author
Article ID: 100049Z09IC2019
Access full text article on other devices
Access PDF of article on other devices
How to cite this article
Castro IH, Campitruz MZ, Aguiar MM, López- Rivera F. Medroxyprogesterone-induced idiopathic intracranial hypertension in a non-obese woman with a negative funduscopic examination. J Case Rep Images Med 2019;5:100049Z09IC2019.ABSTRACT
Introduction: Idiopathic intracranial hypertension (IIH) is an uncommon pathology of unknown etiology that is characterized by chronically elevated intracranial pressure, with manifestations that include headaches that start behind the orbits, tinnitus, and diplopia. The incidence of IIH in the general population is 0.9 per 100,000. The most preponderant risk factors are female sex, obesity and steroid withdrawal. For the diagnosis of IIH, a patient must fulfill the modified Dandy criteria.
Case Report: A 29-yearold female patient using medroxyprogesterone acetate as a contraceptive method for the last two months with no past medical history visited the Emergency Department due to throbbing, holocranial headache 8/10 in intensity. One week before admission, she was treated with ibuprofen, without any improvement. Symptoms included nausea and diplopia. Management included ketorolac, dexamethasone and orphenadrine IV, but there was no improvement. She was admitted to the internal medicine ward due to an intractable headache. Head computed tomography scan showed an empty Sella turcica. Findings were confirmed with a magnetic resonance imaging/ magnetic resonance venography. Lumbar puncture showed elevated intracranial pressure. The headaches disappeared by the sixth week with the discontinuation of Medroxyprogesterone acetate.
Conclusion: The most common risk factors for IIH are female sex and obesity with associated funduscopic findings of papilledema; however, this case demonstrates that IIH cannot be ruled out only on the base of body mass index. Patients suffering from an unusual headache, unresponsive to therapy should be evaluated with an imaging study, even if the funduscopic examination is negative. There are different findings on imaging studies associated with IIH, such as an empty sella turcica and posterior globe flattening.
Keywords: Drug-induced, Headache, Hormonal contraceptive, Idiopathic intracranial hypertension, Intracranial pressure, Medroxyprogesterone acetate
SUPPORTING INFORMATION
Author Contributions
Ivonne Hernández Castro - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mónica Zanconato Campitruz - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mariana Martínez Aguiar - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Fermín López-Rivera - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this case report.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Ivonne Hernández Castro et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
