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Case Reports
. 2018 Dec;97(49):e13365.
doi: 10.1097/MD.0000000000013365.

Mesalazine treatment causing resolution of intracranial hypertension secondary to ulcerative colitis: A case report

Raoul Kanav Khanna  1 , Rabih Hage  1 , Alexandre Hage  1 , Vanessa Polin  2 , Thomas Sené  3 , Catherine Vignal-Clermont  1
Affiliations
Case Reports

Mesalazine treatment causing resolution of intracranial hypertension secondary to ulcerative colitis: A case report

Raoul Kanav Khanna et al. Medicine (Baltimore). 2018 Dec.

Abstract

Rationale: The association between intracranial hypertension (ICH) and ulcerative colitis (UC) is rare. We report the unusual case of a male patient with UC and ICH in whom both conditions resolved with mesalazine therapy.

Patient concerns: A 48-year-old Caucasian man presented to our department in June 2016 for decreased vision, transient visual obscuration, pulsatile tinnitus and headaches of 7 months duration. Bilateral optic disc swelling was found at fundus examination. Brain MRI excluded any brain tumor and lumbar puncture showed cerebrospinal fluid (CSF) opening pressure of 26 cm of water with normal CSF contents.

Diagnoses: Idiopathic ICH was suspected.

Interventions: The patient was managed with oral acetazolamide. Headaches initially improved but the dosage could not be decreased under 750 mg a day without recurrence of the symptoms. Extensive review of systems showed that the patient had active UC. He was given oral mesalazine, 2000 mg a day.

Outcomes: The symptoms of UC and ICH quickly resolved. Acetazolamide was progressively tapered over the course of the 9 subsequent months and the patient did not show any worsening of his symptoms or papilledema.

Lessons: UC should be added to the list of disorders associated with ICH. In case of atypical ICH with drug dependency, investigations should seek for UC. Treating efficiently UC with mesalazine may improve ICH, suggesting an underlying inflammatory process.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Fundus photography. Bilateral papilledema grade 2 and macular folds.
Figure 2
Figure 2
Automatized visual field perimeter 30 central degrees. a and b: Right and left eye in May 2016: enlarged blind spots and peripheral deficits. c and d: Right and left eye in March 2018: normal visual fields.
See this image and copyright information in PMC

References

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