A 15-year-old girl presented to our emergency department with dizziness, anorexia, nausea, and malaise. Clinical examination and magnetic resonance imaging studies showed characteristic features of multiple sclerosis. Surprisingly, a diagnostic lumbar puncture showed significant intracranial hypertension in addition to numerous oligoclonal bands, elevated immunoglobulin G index and immunoglobulin G/albumin ratio in the cerebrospinal fluid. It is proposed that a large burden of active demyelinating disease may cause increased intracranial pressure, thus providing an additional sound rationale for prompt therapeutic administration of intravenous high-dose steroids.
Poser CM, Brinar VVDiagnostic criteria for multiple sclerosis: an historical review. Clin Neurol Neurosurg. 2004;106:147-158.
2.
Naismith RT, Trinkaus K., Cross AHPhenotype and prognosis in African-Americans with multiple sclerosis: a retrospective chart review. Mult Scler. 2006;12:775-781.
3.
Lublin FD, Reingold SCDefining the clinical course of multiple sclerosis: results of an international survey. National Multiple Sclerosis Society (USA) Advisory Committee on Clinical Trials of New Agents in Multiple Sclerosis. Neurology. 1996;46:907-911.
4.
Confavreux C. , Vukusic S.Natural history of multiple sclerosis: a unifying concept. Brain. 2006;129(Pt 3):606-616.
5.
Hahn JS, Pohl D., Rensel M., Rao S.; International Pediatric MS Study Group.Differential diagnosis and evaluation in pediatric multiple sclerosis. Neurology. 2007;68(Suppl 2):S13-S22.
6.
Duquette P., Murray TJ, Pleines J., et al. Multiple sclerosis in childhood: clinical profile in 125 patients . J Pediatr. 1987; 111:359-363.
7.
Newman NJ, Selzer KA, Bell RAAssociation of multiple sclerosis and intracranial hypertension. J Neuroophthalmol. 1994; 14:189-192.
8.
Skoromets AA , Ermolenko IN, Barbas IM, et al. [Efferent methods of the treatment of cerebrospinal fluid hypertension in exacerbation of multiple sclerosis] . Zh Nevropatol Psikhiatr Im S S Korsakova. 1991;91:23-26.
9.
McDonald WI, Compston A., Edan G., et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol. 2001;50:121-127.
10.
Friedman DIMedication-induced intracranial hypertension in dermatology. Am J Clin Dermatol. 2005;6:29-37.
11.
Friedman DI , Jacobson DMIdiopathic intracranial hypertension. J Neuroophthalmol. 2004;24:138-145.
12.
Kepes JJLarge focal tumor-like demyelinating lesions of the brain: intermediate entity between multiple sclerosis and acute disseminated encephalomyelitis? A study of 31 patients. Ann Neurol. 1993;33:18-27.
13.
David P., Uncini A., Scoppetta C.Intracranial hypertension syndrome as initial symptom of late onset multiple sclerosis. A case report. Acta Neurol (Napoli). 1983;5:402-404.
