Anemia and papilledema

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Abstract

Purpose

To elucidate the relationship between anemia and raised intracranial pressure (ICP).

Design

Interventional case series.

Methods

Retrospective case series and review of the literature. Only patients with documented papilledema, neuroimaging ruling out a space-occupying lesion, and anemia were included.

Results

Five women with confirmed idiopathic intracranial hypertension (IIH) (normal brain magnetic resonance imaging, normal cerebrospinal fluid, elevated intracranial pressure), and one man with presumed IIH (normal head computed tomography [CT], no lumbar puncture) were evaluated. All had bilateral papilledema associated with peripapillary hemorrhages. Two had retinal cotton–wool spots (CWS), and two had preretinal hemorrhages. All had severe iron deficiency anemia, which was discovered at the time of their ocular complaints in five of them. Their symptoms and signs improved dramatically after treatment of the anemia. We found 30 well-documented cases in the English and French literature. Among those, 13 were excluded from our analyses (11 had confounding disorders, and two had cerebral venous thrombosis). In the remaining 17 cases, isolated raised ICP associated with anemia was the most likely diagnosis, although in none of these cases was cerebral venous thrombosis excluded.

Conclusions

Anemia may play a role in the occurrence of raised ICP and papilledema. Although only a few cases in the literature support this association, it may be more common than previously thought. Because most patients are not known to be anemic when papilledema is discovered, we suggest that a complete blood count be obtained in patients with IIH, especially in the absence of known associated factors such as obesity or medications or when treatment aimed at lowering ICP fails to improve the patient’s symptoms. The underlying mechanisms remain unknown, but cerebral venous thrombosis should be carefully excluded.

Section snippets

Design

This study was conducted as an interventional case series.

Methods

We retrospectively reviewed six cases with papilledema, isolated raised ICP, and anemia, and reviewed the English and French literature for similar cases. Only cases with documented anemia and disk edema associated with presumed increased ICP were included. Cases with evidence of cerebral venous thrombosis or any other neurologic disease were excluded. The data accumulation is in conformity with all country/federal or state laws.

Results

Our cases included five women with confirmed IIH (normal brain magnetic resonance imaging [MRI], normal cerebrospinal fluid contents, elevated ICP) and one man with presumed IIH (normal head computed tomography [CT], no lumbar puncture performed). All had bilateral papilledema associated with peripapillary hemorrhages; two had retinal cotton-wool spots (CWS) and two had preretinal hemorrhages. All had severe iron deficiency anemia. Their symptoms and signs improved dramatically after treatment

Discussion

Our patients had a clinical syndrome suggestive of IIH and were found to be anemic. It is possible that this may represent a chance association, because both IIH and anemia are common disorders in women of childbearing age.19, 20, 21 Indeed, no properly controlled study has found a statistical association between IIH and anemia.16, 17, 18 However, current knowledge of IIH is limited largely to information gained from retrospective studies. Only a few controlled studies have been performed, each

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  • Cited by (0)

    Dr. Nancy J. Newman is a recipient of a Research to Prevent Blindness Lew R. Wasserman Merit Award.

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