title: Mercury poisoning as a cause of intracranial hypertension.
abstract: Mercury poisoning is a rare but fatal toxicologic emergency. Neurologic manifestations involving the central nervous system are seen usually with chronic mercury intoxication. The most commonly seen complaints are headache, tremor, impaired cognitive skills, weakness, muscle atrophy, and paresthesia. Here, we present a male patient who was chronically exposed to elemental mercury and had papilledema and intracranial hypertension without parenchymal lesion in the central nervous system. A 12-year-old male patient was referred to our emergency room because of severe fatigue, generalized muscle pain and weakness, which was present for a month. Physical examination revealed painful extremities, decreased motor strength and the lack of deep tendon reflexes in lower extremities. He had mixed type polyneuropathy in his electromyography. Whole blood and 24-hour urinary mercury concentrations were high. A chelation therapy with succimer (dimercaptosuccinic acid) was started on the fourth day of his admission. On the seventh day of his admission, he developed headache and nausea, and bilateral papilledema and intracranial hypertension were detected on physical examination. Acetazolamide was started and after 1 month of treatment, the fundi examination was normal. The patient stayed in the hospital for 35 days and was then discharged with acetazolamide, vitamin B6, gabapentin, and followed as an outpatient. His clinical findings were relieving day by day. Although headache is the most common symptom in mercury poisoning, the clinician should evaluate the fundus in terms of intracranial hypertension.
authors.affiliation: Department of Pediatric Neurology, Akdeniz University Medical Faculty, Antalya, Turkey.
authors.forename: Pınar
authors.initials: P
authors.lastname: Gençpınar
authors.affiliation: Department of Pediatrics, Akdeniz University Medical Faculty, Antalya, Turkey.
authors.forename: Başak
authors.initials: B
authors.lastname: Büyüktahtakın
authors.affiliation: Department of Pediatrics, Akdeniz University Medical Faculty, Antalya, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: İbişoğlu
authors.affiliation: Department of Pediatrics, Akdeniz University Medical Faculty, Antalya, Turkey.
authors.forename: Şakir
authors.initials: Ş
authors.lastname: Genç
authors.affiliation: Department of Pediatric Gastroenterology and Hepatology, Akdeniz University Medical Faculty, Antalya, Turkey.
authors.forename: Aygen
authors.initials: A
authors.lastname: Yılmaz
authors.affiliation: Department of Pediatric Genetics, Akdeniz University Medical Faculty, Antalya, Turkey emihci@akdeniz.edu.tr.
authors.forename: Ercan
authors.initials: E
authors.lastname: Mıhçı
mesh_terms: D000086:Acetazolamide / Q000627:therapeutic use*; D015913:Chelation Therapy / Q000379:methods*; D002648:Child; D003156:Community Mental Health Services; D006801:Humans; D019586:Intracranial Hypertension / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008630:Mercury Poisoning / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D010211:Papilledema / Q000209:etiology
chemical_list: D000086:Acetazolamide
keywords: childhood; intracranial hypertension; mercury; papilledema