Clinical resolution of severely symptomatic pseudotumor cerebri after gastric bypass in an adolescent.
Pseudotumor cerebri is a disease characterized by increased intracranial pressure, often manifested by headaches, and occasionally leading to severe visual impairment or even blindness. Most cases in adolescents, as in adults, are associated with obesity. We report a 16-year-old morbidly obese adolescent girl (body mass index 42.3 kg/m(2)) with severely symptomatic pseudotumor cerebri who had progressive visual field deficits and elevated intracranial pressure (opening pressure on lumbar puncture of 50 cm H(2)O) despite intensive medical management and placement of both ventriculoperitoneal and lumboperitoneal shunts. Six months after she underwent gastric bypass surgery, she had lost 43% of her excess body weight and had had near complete regression of her visual field deficits, along with normalization of her intracranial pressures. This case demonstrates the dramatic reversal of symptoms of pseudotumor cerebri with surgically induced weight loss. Gastric bypass should be considered as a treatment option for adolescents with severe and progressive pseudotumor cerebri.
Chandra
Venita
V
Division of Pediatric Surgery, Department of Surgery, Lucile Packard Children's Hospital, Stanford University Medical Center, Standford, California 94305, USA.
Dutta
Sanjeev
S
Albanese
Craig T
CT
Shepard
Elizabeth
E
Farrales-Nguyen
Susan
S
Morton
John
J
D000293:Adolescent; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass; D006801:Humans; D007427:Intracranial Pressure / Q000502:physiology*; D009767:Obesity, Morbid / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D011559:Pseudotumor Cerebri / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D012720:Severity of Illness Index; D014794:Visual Fields