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Malignant idiopathic intracranial hypertension revealed a hidden primary spinal leptomeningeal medulloblastoma
  1. Naim Izet Kajtazi1,
  2. Shahpar Nahrir2,
  3. Wafa Al Shakweer3,
  4. Juman Al Ghamdi4,
  5. Ali Al Fakeeh5 and
  6. Majed Al Hameed1
  1. 1Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
  2. 2Department of Neurology, King Saud Medical Complex, Riyadh, Saudi Arabia
  3. 3Pathology and Clinical Laboratory Administration Department, King Fahad Medical City, Riyadh, Saudi Arabia
  4. 4Medical Imaging Administration, Intervention Neuroradiology, King Fahad Medical City, Riyadh, Saudi Arabia
  5. 5Department of Oncology, Comprehensive Cancer Centre, King Fahad Medical City, Riyadh, Saudi Arabia
  1. Correspondence to Dr Naim Izet Kajtazi; nkajtazi{at}gmail.com

Abstract

Frequently the cause of raised intracranial pressure remains unresolved and rarely is related to spinal tumours, moreover less to spinal medulloblastoma without primary brain focus. An 18-year-old woman had a 3-month history of headache and impaired vision. Neurological examination revealed bilateral sixth cranial nerve palsies with bilateral papilloedema of grade III. No focal brain or spine lesion was found on imaging. Consecutive lumbar punctures showed high opening pressure and subsequent increasing protein level. Meningeal biopsy was negative. At one point, she developed an increasing headache, vomiting and back pain. Spine MRI showed diffuse nodular leptomeningeal enhancement with the largest nodule at T6–T7. Malignant cells were detected in cerebrospinal fluid. She underwent laminectomy with excisional biopsy, and pathology showed medulloblastoma WHO grade IV. She was treated with chemotherapy and craniospinal irradiation and made a good recovery.

  • headache (including migraines)
  • neuroimaging
  • neuro-ophthalmology
  • spinal cord

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Footnotes

  • Contributors NIK has contributed to the case report design, planning, scanned file review, writing patient history, investigations, treatment, follow-up, interpretation of data, and the intellectual content of the manuscript; coordinated work with other coauthors; and submitted the manuscript on behalf of all of them. SN has contributed to the interpretation of data, literature review, discussion part and intellectual content of the manuscript. WAS has contributed to the selection and annotation of the pathology slide pictures. JAG has contributed to the selection of good quality radiology images from PACS with annotations. AAF has contributed to the interpretation of data, literature review, discussion part, and the intellectual content of the manuscript, and obtained patient consent. MAH has contributed to the intellectual content of the manuscript and supervised the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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