title: Hydrocephalus during natalizumab treatment.
abstract: Natalizumab is a humanized monoclonal antibody recently approved for multiple sclerosis treatment. Although generally well tolerated and efficacious in multiple sclerosis treatment, it raised concerns after the occurrence of some cases of progressive multifocal leucoencephalopathy in exposed patients. Extensive and prolonged use of natalizumab could unmask further unexpected side effects. We describe the case of a woman suffering from multiple sclerosis who experienced an acute tetra-ventricular hydrocephalus soon after the beginning of immunomodulating treatment with natalizumab. The patient was also affected with a VIII cranial nerve Schwannoma treated with stereotactic radiosurgery 2 years before, with subsequent clinical and radiological stabilization. The strict temporal correlation between clinical worsening and natalizumab therapy points to a possible triggering role of the drug in the pathogenesis of hydrocephalus in our patient. Treating neurologists should be aware of this possible complication in selected subsets of patients.
authors.affiliation: Servizio Cantonale di Neurologia, Ospedale Civico, via Tesserete 46, 6903, Lugano, Switzerland. chiara.zecca@eoc.ch
authors.forename: Chiara
authors.initials: C
authors.lastname: Zecca
authors.forename: Claudio
authors.initials: C
authors.lastname: Städler
authors.forename: Claudio
authors.initials: C
authors.lastname: Gobbi
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000139:chemically induced* / Q000175:diagnosis; D007155:Immunologic Factors / Q000009:adverse effects / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging / Q000379:methods; D009103:Multiple Sclerosis / Q000188:drug therapy*; D000069442:Natalizumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007155:Immunologic Factors; D000069442:Natalizumab
references.citation: Ann Neurol. 2009 Sep;66(3):403-6
references.pmid: 19798640
references.citation: N Engl J Med. 2006 Mar 2;354(9):911-23
references.pmid: 16510745
references.citation: Nat Genet. 1993 Aug;4(4):421-5
references.pmid: 8401593
references.citation: Neurology. 2009 Oct 27;73(17):1418-9
references.pmid: 19776379
references.citation: J Neurosurg. 2003 Oct;99(4):685-92
references.pmid: 14567604
references.citation: N Engl J Med. 2008 Feb 7;358(6):647-8
references.pmid: 18256405
references.citation: J Clin Invest. 2005 Jun;115(6):1542-51
references.pmid: 15902308
references.citation: Lancet Neurol. 2009 Jan;8(1):28-31
references.pmid: 19081511