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Nehali Nanawati, Elliot Crane, Kunjal K Modi, Roger Turbin, Larry Frohman; Treatment of Secondary Pseudotumor Cerebri from Severe Anemia with Blood Transfusion. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3316. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
We aim to investigate blood transfusion as a treatment for patients with pseudotumor cerebri (PC) secondary to severe iron deficiency anemia.
This is a retrospective case series of three patients with PC and anemia diagnosed after lumbar puncture, neurologic imaging, and completion of extensive workup to rule out other secondary causes. Patients with pre-transfusion hemoglobin (Hb) levels less than 9 g/dl were included. Ocular and neurologic signs and symptoms of PC, as well as hemoglobin levels, were assessed on presentation and after transfusion.
3 women in their twenties with secondary PC due to severe anemia, 2 from gynecologic blood loss and 1 from pancytopenia, were identified. All patients had disc edema on presentation. Presenting hemoglobin levels were 6.2, 5.4, and 5.6 g/dl. All patients were transfused with final hemoglobin levels of 8.2, 8.9, and 10.7 g/dl, respectively (Table 1).Case 1: 20 year-old (yo) female with heavy menstrual bleeding presented with severe headache (HA), pulsatile tinnitus (PT), and transient visual obscuration (TVO). She had an initial Hb of 6.2 and visual field (VF) changes on automated perimetry. Her BMI was 21.8. She was transfused with 2 units of red blood cells (RBC), which raised her Hb to 8.2, followed by acetazolamide. HA, PT, and TVO resolved by the following day. VA and VF also improved.Case 2: 26 yo female with heavy menstrual bleeding presented with HA, PT, and TVO. She had an initial Hb of 5.4 and was morbidly obese (BMI = 50.2). She was treated with acetazolamide and transfused with 4 units of RBC, which raised her Hb to 8.9. HA, PT, and TVO resolved 2 days post-transfusion.Case 3: 24 yo female with idiopathic pancytopenia presented with HA, PT, and TVO with visual loss in the right eye. Her initial Hb was 5.6 and BMI was 30.1. Fundus exam revealed Roth spots in the right eye. She was treated with high dose steroids and transfused with 4 units of RBC which raised her Hb to 10.7. Her symptoms resolved by 5 days post-transfusion; the papilledema was resolving. No other cause for the Roth spots was found.
All three patients with PC and severe anemia in our case series demonstrated rapid resolution of symptoms of PC (HA, PT, and TVO) after blood transfusion. In patients with PC secondary to severe anemia, anemia correction with blood transfusions may help to alleviate symptoms and obviate the need for surgical intervention.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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