Attention deficit hyperactivity disorder: diagnosis and treatment masking the ophthalmic clinical presentation of a pineal gland tumour in a teenager.
A 17-year-old male was found to have a fourth cranial nerve palsy and chronic papilloedema following his presentation to our institution with a 6-week history of blurred vision in both eyes and vertical binocular diplopia. A diagnosis of pineal germinoma was made following imaging studies and endoscopic neurosurgical biopsy of the tumour. He was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) 3 years earlier and treated with amphetamines. Since this diagnosis, he continued to suffer from hyperactive behaviour, poor concentration, worsening headaches and insomnia. Pineal pathology has a known association with sleep disturbance through the disturbance of melatonin synthesis and/or metabolism. This case report serves to highlight how the presence of organic brain disease presenting to an eye department can be masked by a diagnosis of ADHD.
Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY, England, UK. gercunniffe@doctors.net.uk
G
G
Cunniffe
R
R
Murthy
B
B
Beigi
D000293:Adolescent; D000662:Amphetamines / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000188:drug therapy*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy; D003937:Diagnosis, Differential; D005654:Fundus Oculi; D018237:Germinoma / Q000175:diagnosis* / Q000532:radiotherapy; D006801:Humans; D008297:Male; D010211:Papilledema / Q000175:diagnosis; D010870:Pineal Gland; D010871:Pinealoma / Q000175:diagnosis* / Q000532:radiotherapy; D014057:Tomography, X-Ray Computed
D000662:Amphetamines