Intracranial Hypertension in a Patient with a Chiari Malformation Accompanied by Hyperthyroidism

Pang, Chang Hwan; Lee, Soo Eon; Kim, Chi Heon; Chung, Chun Kee

doi:10.14245/kjs.2015.12.3.150

Cited by 2 publications

(2 citation statements)

References 15 publications

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“…One case reported by Herwig et al describes a 32-year-old woman suffering from Grave's and new hydrocephalus that then resolved after propranolol and carbimazole [15]. Similarly, other reports of hydrocephalus or idiopathic intracranial hypertension and CM1 have been associated with hyperthyroidism [16][17][18].…”

Section: Could Hyperthyroidism Precipitate a Syrinx?mentioning

confidence: 99%

Resolution of Large Cervico-Thoracic Syringomyelia Following Treatment of Thyrotoxicosis: A Case Report

Craven¹,

Mullins²,

Pradini-Santos³

et al. 2023

Cureus

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Treatment for a large symptomatic syrinx associated with a Chiari 1 is predominately surgical, via a foramen magnum decompression (FMD), with the aim to normalise cerebrospinal fluid (CSF) movement. Whilst theories of underlying hyperdynamic states in Chiari 1 and Syringomyelia exist, to date there is no effective medical treatment to reverse Syringomyelia. A 17-year-old female was referred with a seven-month history of gradually progressive impaired temperature sensation in her left upper limb. She had also been concomitantly diagnosed with thyrotoxicosis. Magnetic resonance imaging (MRI) confirmed a Chiari 1 with a large syrinx. The patient preferred to avoid surgery in the first instance. She underwent treatment for her thyrotoxicosis. The eight-month, 20- and 36-month follow-up MRI scans demonstrated a gradual resolution of the Chiari 1 malformation and the syrinx. Whilst there have been reports of Chiari 1 malformation association with hyperthyroidism, this is the first report describing syrinx resolution following treatment of thyrotoxicosis. Hyperdynamic circulation can result in syrinx formation through various mechanisms. We hypothesise that the treatment of thyrotoxicosis resulted in normalisation of CSF pulse amplitude and subsequent syrinx resolution. Hyperthyroidism evaluation may be explored in studies of CM1 and Syrinx or other CSF disorders.

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Section: Could Hyperthyroidism Precipitate a Syrinx?mentioning

confidence: 99%

Resolution of Large Cervico-Thoracic Syringomyelia Following Treatment of Thyrotoxicosis: A Case Report

Craven¹,

Mullins²,

Pradini-Santos³

et al. 2023

Cureus

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“…was started. Since no other causes of IH, such as Chiari malformation [16] or cerebral venous sinus thrombosis [17], were found, a possible relation to Graves’ disease in this (now) three-year-old child on chronic thiamazole monotherapy could not be fully excluded. Papilledema in both eyes completely resolved within weeks, and acetazolamide therapy was stopped after 2 months.…”

Section: Case Reportmentioning

confidence: 99%

Recurrent Intracranial Hypertension in a Toddler with Graves’ Disease

et al. 2022

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Idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure without an evident cause. Obesity and the female sex have been recognized as risk factors for the development of this syndrome. Until now, Graves’ disease has only been described in the literature as the probable cause of IIH in 7 patients. This report describes the case of a young girl with Graves’ disease presenting with symptoms of intracranial hypertension. A 21-month-old girl presented with progressive symptoms of poor weight gain and bilateral exophthalmos. She also experienced difficulty sleeping, diarrhea multiple times per day, irritability and heat intolerance. Laboratory investigation showed elevated free T4, fully suppressed TSH and elevated anti-TSH antibodies, consistent with a diagnosis of new-onset Graves’ disease. She was successfully treated with monotherapy thiamazole, titrated to the lowest possible dose of 1,25 mg once daily with normalization of thyroid function tests within 3 months of treatment initiation. After 18 months of treatment, her condition unexpectedly deteriorated as papilledema and slight esotropia was found at routine checkup. An MRI and lumbar puncture showed increased intracranial pressure, but no underlying anatomical cause for the intracranial hypertension was found. Acetazolamide therapy was started, and papilledema in both eyes resolved within weeks. Unfortunately, papilledema has recurred several times over the following 2 years when attempts were made to decrease the acetazolamide dose. This case report is the first to describe a very young patient who developed significant IIH in the chronic stage of Graves’ disease. IIH development seemed to be related to the progression of the Graves’ ophthalmopathy, rather than initiation of thiamazole therapy or fluctuations in serum fT4 levels.

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Intracranial Hypertension in a Patient with a Chiari Malformation Accompanied by Hyperthyroidism

Cited by 2 publications

References 15 publications

Resolution of Large Cervico-Thoracic Syringomyelia Following Treatment of Thyrotoxicosis: A Case Report

Resolution of Large Cervico-Thoracic Syringomyelia Following Treatment of Thyrotoxicosis: A Case Report

Recurrent Intracranial Hypertension in a Toddler with Graves’ Disease

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