Pseudotumor Cerebri Complicating Measles

J Millichap

doi:10.15844/pedneurbriefs-20-6-3

Author:

J Gordon Millichap

Northwestern University Feinberg School of Medicine, US

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Abstract

A novel case of pseudotumor cerebri (PTC) that presented in an 8-year-old girl 3 weeks after measles is reported from Ondokuz Mayis University, Samsun, Turkey.

How to Cite: Millichap, J.G., 2006. Pseudotumor Cerebri Complicating Measles. Pediatric Neurology Briefs, 20(6), pp.43–43. DOI: http://doi.org/10.15844/pedneurbriefs-20-6-3

Published on 01 Jun 2006

CC BY 4.0

A novel case of pseudotumor cerebri (PTC) that presented in an 8-year-old girl 3 weeks after measles is reported from Ondokuz Mayis University, Samsun, Turkey. She was admitted with severe headache, vomiting, retroorbital pain and photophobia. Examination revealed normal temperature and mental orientation, and no meningeal irritation. Visual acuity was 20/20, visual fields were full, and funduscopic examination showed bilateral papilledema with tortuous vessels. EEG, MRI and cranial CT performed 7 days after hospitalization were normal, and MR venography performed 27 days later showed no signs of sinus vein thrombosis. CSF opening pressure on lumbar puncture was 30 cm H20. Laboratory studies were negative except for elevated serum varicella immunoglobulin G (243 AU) and measles immunoglobulin M (183 AU) titers. Following treatment with prednisolone, mannitol, acetazolamide and furosemid, headache improved in 5 days, and in 14 days, the patient was symptom free, with normal CSF pressure (6-12 cm H20). Withdrawal of prednisolone and reduction in acetazolamide were followed by relapse and temporary renewal of therapy. A repeat lumbar puncture 2 months later revealed a CSF pressure of 12 cm H20, and funduscopic examination was normal. A post measles autoimmune-mediated vasculitis is postulated as the cause of PTC in this child. [1]

COMMENT. Reports of infectious or post-infectious disorders associated with pseudotumor cerebri (PTC) have included sinusitis, otitis media, mastoiditis, HIV, Lyme disease, SSPE [2], and varicella [3]. PTC was initially considered in a case of zoster-associated intracranial hypertension in a 14-year-old female who presented with headache, vomiting, rash and papilledema [4]. Despite the absence of fever or meningism and the child's high body mass index in keeping with PTC, the finding of CSF pleocytosis and elevated protein was inconsistent with the diagnosis, and varicella-zoster virus reactivation was invoked as the cause. Given the elevated serum varicella immunoglobulin G, a measles-induced reactivation of varicella virus in the present case might have been considered by repeat serology during convalescence. [5, 6]

References

Tasdemir, HA, Dilber, C, Totan, M and Onder, A (2006). Pseudotumor cerebri complicating measles: A case report and literature review. Brain Dev July 200628: 395–397, DOI: https://doi.org/10.1016/j.braindev.2005.10.014 [PubMed]

Tan, H, Orhan, A, Büyükavci, M and Koçer, I (2004). Pseudotumor cerebri secondary to subacute sclerosing panencephalitis. J Child Neurol Aug 200419(8): 627–629, DOI: https://doi.org/10.1177/088307380401900813 [PubMed]

Konrad, D, Kuster, H and Hunziker, UA (1998). Pseudotumour cerebri after varicella. Eur J Pediatr Nov 1998157(11): 904–906, DOI: https://doi.org/10.1007/s004310050964 [PubMed]

Millichap, JJ and Freeman, JL (2005). Zoster-associated intracranial hypertension. Pediatr Neurol Mar 200532(3): 211–212, DOI: https://doi.org/10.1016/j.pediatrneurol.2004.09.002 [PubMed]

Suga, S, Yoshikawa, T, Asano, Y, Nakashima, T, Kobayashi, I and Yazaki, T (1992). Activation of human herpesvirus-6 in children with acute measles. J Med Virol Dec 199238(4): 278–282, DOI: https://doi.org/10.1002/jmv.1890380409 [PubMed]

Hall, CB Long, CE Schnabel, KC Caserta, MT McIntyre, KM Costanzo, MA et al. (1994). Human herpesvirus-6 infection in children. A prospective study of complications and reactivation. N Engl J Med Aug 1994331(7): 432–438, DOI: https://doi.org/10.1056/NEJM199408183310703 [PubMed]

[CIT0001] Tasdemir, HA, Dilber, C, Totan, M and Onder, A (2006). Pseudotumor cerebri complicating measles: A case report and literature review. Brain Dev July 200628: 395–397, DOI: https://doi.org/10.1016/j.braindev.2005.10.014 [PubMed]

[CIT0002] Tan, H, Orhan, A, Büyükavci, M and Koçer, I (2004). Pseudotumor cerebri secondary to subacute sclerosing panencephalitis. J Child Neurol Aug 200419(8): 627–629, DOI: https://doi.org/10.1177/088307380401900813 [PubMed]

[CIT0003] Konrad, D, Kuster, H and Hunziker, UA (1998). Pseudotumour cerebri after varicella. Eur J Pediatr Nov 1998157(11): 904–906, DOI: https://doi.org/10.1007/s004310050964 [PubMed]

[CIT0004] Millichap, JJ and Freeman, JL (2005). Zoster-associated intracranial hypertension. Pediatr Neurol Mar 200532(3): 211–212, DOI: https://doi.org/10.1016/j.pediatrneurol.2004.09.002 [PubMed]

[CIT0005] Suga, S, Yoshikawa, T, Asano, Y, Nakashima, T, Kobayashi, I and Yazaki, T (1992). Activation of human herpesvirus-6 in children with acute measles. J Med Virol Dec 199238(4): 278–282, DOI: https://doi.org/10.1002/jmv.1890380409 [PubMed]

[CIT0006] Hall, CB Long, CE Schnabel, KC Caserta, MT McIntyre, KM Costanzo, MA et al. (1994). Human herpesvirus-6 infection in children. A prospective study of complications and reactivation. N Engl J Med Aug 1994331(7): 432–438, DOI: https://doi.org/10.1056/NEJM199408183310703 [PubMed]

Reading: Pseudotumor Cerebri Complicating Measles

Post-Infectious CNS Disorders

Pseudotumor Cerebri Complicating Measles

Author:

J Gordon Millichap

Northwestern University Feinberg School of Medicine, US

X close

Abstract

References