Pseudotumor cerebri is a syndrome associated with diverse putative etiological factors that include chemicals such as vitamin A, tetracycline and estrogens or venous circulatory disturbances like sagittal or transverse sinus thrombosis. Diseases predisposing to thrombosis, such as polycythemia vera and essential thrombocythemia, were reported to cause sinus thrombosis and pseudotumor cerebri. This is a pilot study to investigate the possible role of hemostatic factors in the pathogenesis of pseudotumor cerebri. We studied nine patients with severe, recurrent, or refractory pseudotumor cerebri causing visual impairment and found abnormal euglobulin clot lysis time (prestress in all of them and post stress in seven). Digital subtraction angiography was suggestive of recanalized sinus thrombosis in only three patients. We conclude that abnormalities in the fibrinolytic system are present in a subset of patients with severe pseudotumor cerebri, which calls for further studies on venous circulatory pathogenesis of pseudotumor cerebri and the possible role of anticoagulants in such cases. Ann Saudi Med 1993;13 (5) Pseudotumor cerebri (PTC) is defined as a syndrome characterized by increased intracranial pressure without a space-occupying lesion, hydrocephalus, or infection. Its pathogenesis is obscure. It is more common in young females, and usually associated with one of many diverse conditions. The name "benign intracranial hypertension" was introduced by Foley in 1955 [12], but the incidence of severe visual loss has been reported to be 6% [5] to 12% [4] and even higher if follow-up is long enough [7]. We have followed a group of patients with a severe, protracted or recurrent course of PTC in an attempt to identify the risk factors, especially those related to the coagulation system of the blood. Patients and MethodsFrom a group of patients attending the neurology or neuro-ophthalmology clinic, we selected nine (one male and eight females from age 16 to 46 years) with severe acute illness leading to impairment of visual function (i.e., visual acuity the criteria for PTC, namely, papilledema, normal decreased below 20/100, and/or visual field constriction by over 50%) or a prolonged (more than six months) or recurrent course of illness, or in whom there was failure to conventional medical therapy. All patients fulfilled neurological examination, normal head CT scan before and after injection of contrast medium (100 ml of renograffin 60), raised lumbar CSF pressure over 240 mm/H 2 O, and normal CSF analysis. Four subjects served as controls and were as follows: one patient with increased CSF pressure due to viral meningitis, one with tension headache, one epileptic, and one hospital employee (ages 22 to 34 years). The four controls matched four patients with whom their tests were paired. Hemostasis system studies included platelet count, prothrombin time, activated partial thromboplastin time, fibrinogen, thrombin clotting time, reptilase time, antithrombin III, factor VIII clotting activity, factor VIII Von Willebr...
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