Spinal cord astrocytoma presenting as "idiopathic" intracranial hypertension.
Increased intracranial pressure is rarely seen in association with spinal tumors. We describe a young, non-obese man who presented with increased intracranial pressure, papilledema and visual obscuration. Multiple cerebrospinal fluid (CSF) examinations with normal or minimally elevated CSF protein lead to the initial diagnosis of idiopathic intracranial hypertension. After a lumboperitoneal shunt placement a progressive thoracic myelopathy developed 7 months after onset of symptoms. The spinal MRI showed a low cervical-upper thoracic intramedullary tumor. Open biopsy confirmed a grade 3 fibrillary astrocytoma. The suspected mechanisms of spinal tumors causing increased intracranial pressure are reviewed as well as three other cases of spinal astrocytomas previously reported in the literature that presented with papilledema and increased intracranial pressure without hydrocephalus. This case illustrates that increased intracranial pressure may in exceptional cases of spinal tumors precede the more typical myelopathic presentation by months and mimic idiopathic intracranial hypertension.
Porter
Alyx
A
Department of Neurology, Mayo Clinic, Rochester, 200 1st Street SW, Rochester, MN 55905, USA. Porter.alyx@mayo.edu
Lyons
Mark K
MK
Wingerchuk
Dean M
DM
Bosch
E Peter
EP
D000328:Adult; D001254:Astrocytoma / Q000175:diagnosis* / Q000473:pathology; D001706:Biopsy; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D010211:Papilledema / Q000209:etiology; D011559:Pseudotumor Cerebri / Q000209:etiology*; D013116:Spinal Cord / Q000473:pathology; D013120:Spinal Cord Neoplasms / Q000175:diagnosis* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014786:Vision Disorders / Q000209:etiology