Benign Intracranial Hypertension in Association with Acute Lymphoblastic Leukemia

Abstract

Benign intracranial hypertension, also known as pseudotumor cerebri, is a headache syndrome characterized by (1) raised cerebrospinal fluid (CSF) pressure in the absence of an intracranial mass lesion or ventricular dilatation; (2) normal spinal fluid composition; (3) usually normal findings on neurological examination, except for papilloedema and an occasional VI nerve palsy; and (4) normal level of consciousness [1]. It is an uncommon condition in childhood, presenting once or twice a year in a large referral hospital. Although described as benign, the condition can disrupt normal life and cause significant visual failure. Early recognition and management may help alleviate symptoms and preserve vision. We report a case of 14-year-old boy with T-cell acute lymphoblastic leukemia who developed pseudotumor cerebri during the consolidation phase of treatment. CASE REPORTOur patient was a 14-year-old boy first seen in December 2000 with a history of generalized lymphadenopathy and weight loss. Examination revealed significant cervical lymphadenopathy and pallor. Full blood count at diagnosis revealed hemoglobin of 13.1 g/L, white cell count of 19 × 10 9 /L, and a platelet count of 85 × 10 9 /L. Peripheral blood smear revealed blast cells, and bone marrow examination confirmed the diagnosis of acute lymphoblastic leukemia and immunophenotyping confirmed it to be T-cell leukemia. All parts of his coagulation profile, including a prothrombin time, activated partial thromboplastin time, thrombin time, and serum fibrinogen, were all within normal limits. He was commenced on chemotherapy according to Regimen B of MRC ALL 97/99 protocol. He tolerated the initial induction chemotherapy (weeks 1-4) well. This included prednisolone (40 mg/m 2 ) for