52
Letters to the Editor
Pseudotumor cerebri mimicking hyperemesis gravidarum October lOth, 1991
To the Editor
Pseudotumor cerebri, a disorder whose symptoms may include headache, occasional visual obscuration, nausea, vomiting, tinnitus and diplopia is caused by impaired cerebrospinal fluid reabsorption [ 1,3]. To our knowledge, pseudotumor cerebri mimicking hyperemesis gravidarum has not been reported. A 19-year-old woman with a history of pseudotumor cerebri presented at 7 weeks gestation with a headache and occasional nausea and vomiting. Papilledema was found on examination. A recent MRI scan of the brain was normal. A lumbar puncture demonstrated an elevated opening pressure of 40 cmHzO (normal < 20 cm). Her symptoms abated immediately after lumbar puncture. One week later, severe nausea and vomiting without a headache began. The patient was hospitalized for dehydration. Physical examination revealed papilledema. Her serum electrolytes showed a metabolic alkalosis. She was initially suspected of having hyperemesis gravidarum due to the absence of a headache. However, treatment for 2 days with intravenous antiemetics and hydration failed to alleviate her symptoms. A lumbar puncture was performed and the opening pressure was 49 cmH20. Her nausea and vomiting abated the same day and she was discharged the next day. Two additional lumbar punctures showing elevated opening pressures have since been done. Presently, the patient is asymptomatic, on no medication, with
Keywords:
Hyperemesis
Vomiting.
Int J Gym01
Obstet 37
gravidarum;
Pseudotumor
cerebri;
periodic lumbar punctures as the sole mode of therapy. Headache is the most consistent presenting symptom in patients with pseudotumor cerebri, reported to occur in 99% of cases while nausea and vomiting occur in only 32% of cases [l]. Pseudotumor cerebri without headache, and with nausea and vomiting as the sole indication of increased intracranial pressure, has not been reported as far as we know. Although physical examination showed papilledema, this finding may persist in adequately treated pseudotumor patients and did not aid in the diagnosis of pseudotumor cerebri versus hyperemesis gravidarum [3]. Our patient had been refractory to antiemetic medication but had prompt relief of symptoms after lumbar puncture confirming pseudotumor cerebri as the etiology of her nausea and vomiting. Persistent nausea and vomiting can be a manifestation of elevated intracranial pressure and merits careful consideration in the absence of other causes of intractable nausea and vomiting [2]. R.L.
Pearlman
2022 Brookwood
Medical
J.B. Riser E.S. Riser
Birmingham,
Center Drive Suite G-102 AL 35209, USA
References Johnston I, Paterson A: Benign intracranial hypertension. 1. Diagnosis and prognosis. Brain 97: 289. 1974. Malagelada JR, Camilleri M: Unexplained vomiting: a diagnostic challenge. Ann Intern Med 101: 21 I. 1984. Sorenson PS, Krogsaa B. Gjerris F: Clinical course and prognosis of pseudotumor cerebri. A prospective study of 24 patients. Acta Neural Stand 77: 164, 1988.
Letters to the Editor
Pseudotumor cerebri mimicking hyperemesis gravidarum October lOth, 1991
To the Editor
Pseudotumor cerebri, a disorder whose symptoms may include headache, occasional visual obscuration, nausea, vomiting, tinnitus and diplopia is caused by impaired cerebrospinal fluid reabsorption [ 1,3]. To our knowledge, pseudotumor cerebri mimicking hyperemesis gravidarum has not been reported. A 19-year-old woman with a history of pseudotumor cerebri presented at 7 weeks gestation with a headache and occasional nausea and vomiting. Papilledema was found on examination. A recent MRI scan of the brain was normal. A lumbar puncture demonstrated an elevated opening pressure of 40 cmHzO (normal < 20 cm). Her symptoms abated immediately after lumbar puncture. One week later, severe nausea and vomiting without a headache began. The patient was hospitalized for dehydration. Physical examination revealed papilledema. Her serum electrolytes showed a metabolic alkalosis. She was initially suspected of having hyperemesis gravidarum due to the absence of a headache. However, treatment for 2 days with intravenous antiemetics and hydration failed to alleviate her symptoms. A lumbar puncture was performed and the opening pressure was 49 cmH20. Her nausea and vomiting abated the same day and she was discharged the next day. Two additional lumbar punctures showing elevated opening pressures have since been done. Presently, the patient is asymptomatic, on no medication, with
Keywords:
Hyperemesis
Vomiting.
Int J Gym01
Obstet 37
gravidarum;
Pseudotumor
cerebri;
periodic lumbar punctures as the sole mode of therapy. Headache is the most consistent presenting symptom in patients with pseudotumor cerebri, reported to occur in 99% of cases while nausea and vomiting occur in only 32% of cases [l]. Pseudotumor cerebri without headache, and with nausea and vomiting as the sole indication of increased intracranial pressure, has not been reported as far as we know. Although physical examination showed papilledema, this finding may persist in adequately treated pseudotumor patients and did not aid in the diagnosis of pseudotumor cerebri versus hyperemesis gravidarum [3]. Our patient had been refractory to antiemetic medication but had prompt relief of symptoms after lumbar puncture confirming pseudotumor cerebri as the etiology of her nausea and vomiting. Persistent nausea and vomiting can be a manifestation of elevated intracranial pressure and merits careful consideration in the absence of other causes of intractable nausea and vomiting [2]. R.L.
Pearlman
2022 Brookwood
Medical
J.B. Riser E.S. Riser
Birmingham,
Center Drive Suite G-102 AL 35209, USA
References Johnston I, Paterson A: Benign intracranial hypertension. 1. Diagnosis and prognosis. Brain 97: 289. 1974. Malagelada JR, Camilleri M: Unexplained vomiting: a diagnostic challenge. Ann Intern Med 101: 21 I. 1984. Sorenson PS, Krogsaa B. Gjerris F: Clinical course and prognosis of pseudotumor cerebri. A prospective study of 24 patients. Acta Neural Stand 77: 164, 1988.
