Year 2016, Volume 2, Issue 3, Pages 236 - 239 2016-08-07

Spontaneous intracranial hypotension in Graves’ disease

Guven Baris Cansu [1] , Babur Dora [2] , Kamil Karaali [3] , Ramazan Sari [4]

846 622

Autoimmune thyroid disorders such as hyperthyroidism and hypothyroidism are rare causes of intracranial pressure alterations. We present a case of spontaneous intracranial hypotension associated with Graves’ disease which was not reported previously in the literature. A 42-year-old woman was admitted to our institution because of a sudden developed headache, neck pain, nausea and vomiting. The headache was severe during standing and walking but improved within 15 to 30 minutes after lying down. Thyroid gland was grade 1b diffuse palpable and other physical examinations were normal. Autoimmune hyperthyroidism was diagnosed according to laboratory results. Gadolinium-enhanced magnetic resonance imaging revealed a hyperintensity that is consistent with thickened dura and subdural effusion. The patient was managed with bed rest, hydration, methimazole, methyl-prednisolone 16 mg/day of three days and then tapered gradually. After these medications the headache resolved. It should be kept in mind that encephalopathy associated autoimmune thyroid disease may be related with spontaneous intracranial hypotension. 

Intracranial hypotension, autoimmune thyroiditis; thyrotoxicosis
  • Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004;24 Suppl 1:9-160.
  • Schievink WI, Meyer FB, Atkinson JL, Mokri B. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. J Neurosurg 1996;84:598-605.
  • Tamagno G, Celik Y, Simo R, Dihne M, Kimura K, Gelosa G, et al. Encephalopathy associated with autoimmune thyroid disease in patients with Graves' disease: clinical manifestations, follow-up, and outcomes. BMC Neurol 2010;10:27.
  • Merkenschlager A, Ehrt O, Muller-Felber W, Schmidt H, Bernhard MK. Reversible benign intracranial hypertension in a child with hyperthyroidism. J Pediatr Endocrinol Metab 2008;21:1099-101.
  • Schievink WI. Spontaneous spinal cerebrospinal fluid leaks. Cephalalgia 2008;28:1345-56.
  • Schaltenbrand G. [Neure anschauungen zur pathophyiologie der liquorzirkulation]. Zentrablbl Neurochir 1938;3:290-300. [Article in German]
  • Mokri B, Krueger BR, Miller GM, Piepgras DG. Meningeal gadolinium enhancement in low-pressure headaches. J Neuroimaging 1993;3:11-5.
  • Meltzer CC, Fukui MB, Kanal E, Smirniotopoulos JG. MR imaging of the meninges. Part I. Normal anatomic features and nonneoplastic disease. Radiology 1996;201:297-308.
  • Ferracci F, Carnevale A. The neurological disorder associated with thyroid autoimmunity. J Neurol 2006;253:975-84.
  • Castillo P, Woodruff B, Caselli R, Vernino S, Lucchinetti C, Swanson J, et al. Steroid-responsive encephalopathy associated with autoimmune thyroiditis. Arch Neurol 2006;63:197-202.
  • Kumar A, Kilaikode S, Saenger P. Pseudotumor cerebri caused by uncontrolled Graves’ disease in an adolescent. Int J Case Rep Images 2013;4:702-4.
  • Coutinho E, Silva AM, Freitas C, Santos E. Graves' disease presenting as pseudotumor cerebri: a case report. J Med Case Rep 2011;5:68.
Journal Section Case Reports
Authors

Author: Guven Baris Cansu
Institution: Department of Endocrinology and Metabolism, Yunusemre State Hospital, Eskisehir
Country: Turkey


Author: Babur Dora
Institution: Department of Neurology, Akdeniz University School of Medicine, Antalya
Country: Turkey


Author: Kamil Karaali
Institution: Department of Radiology, Akdeniz University School of Medicine, Antalya
Country: Turkey


Author: Ramazan Sari
Institution: Department of Endocrinology and Metabolism, Akdeniz University School of Medicine, Antalya
Country: Turkey


EndNote %0 The European Research Journal Spontaneous intracranial hypotension in Graves’ disease %A Guven Baris Cansu , Babur Dora , Kamil Karaali , Ramazan Sari %T Spontaneous intracranial hypotension in Graves’ disease %D 2016 %J The European Research Journal %P -2149-3189 %V 2 %N 3 %R doi: 10.18621/eurj.2016.5000191479 %U 10.18621/eurj.2016.5000191479