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Systemic lupus erythematosus-induced intracranial hypertension: rare but important
  1. Sana Khan1,
  2. Edward M Vital2,3,
  3. Ajay Patil4,
  4. Stuart Currie5,
  5. Oliver Backhouse4,
  6. Jane Alty6,7
  1. 1Department of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
  2. 2Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
  3. 3NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  4. 4Department of Ophthalmology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  5. 5Department of Neuroradiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  6. 6Department of Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
  7. 7Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, Tasmania, Australia
  1. Correspondence to A/Professor Jane Alty; jane.alty{at}utas.edu.au

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Case

A 19-year-old woman (body mass index 19 kg/m2) presented to the emergency department with a 1-week history of postural headaches and visual obscurations, worse when supine. She had bilaterally reduced visual acuity, enlarged blind spots and papilloedema (figure 1A,B). The remaining neurological examination, and a CT scan of head, was normal. She was admitted for investigation of her papilloedema.

Figure 1

Clinical and imaging abnormalities. Grade two papilloedema of the right (A) and leftB) fundi. (C) shows ulceration of the hard palate, classic for active cutaneous lupus and would be an unusual location for idiopathic aphthous ulceration. (D) shows active lesions of acral lupus on the palmar surfaces of the hand. (E) shows MR scan of brain (axial T2-weighted images) through the orbits; the top and middle images show flattening of the globes (black arrows) and increased prominence of the optic nerve sheath complexes (white arrows); the bottom image shows comparison to an image taken from a healthy age-matched control.

Further evaluation identified a recent history of palatal …

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Footnotes

  • Twitter @janealty1

  • Contributors SK: writing first draft, revision of manuscript, contribution to figure 1, obtaining patient consent. EV: revision of manuscript, rheumatology expertise, contribution to figure 1. AP: revision of manuscript, ophthalmology expertise, contribution to figure 1. SC: revision of manuscript, neuroradiology expertise; contribution to figure 1. OB: revision of manuscript, ophthalmology expertise, contribution to figure 1. JA: conception of idea, neurologist responsible for overall medical care of patient, revision of manuscript, contribution to figure 1.

  • 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 EV has received research grants paid to his employer and consulting fees from Roche and Genentech. JA receives medical textbook royalties from Taylor and Francis, holds shares in ClearSky Medical Diagnostics, has received speaker fees from Allergan & Stada, and advisory board payments from Abbvie and Merz.

  • Provenance and peer review Not commissioned; externally peer reviewed by Susan Mollan, Birmingham, UK.

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