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Topics:
General Internal Medicine • Rheumatology • Systemic lupus erythematosus • Neurology • Neuro-Ophthalmology • neurolupus
How do you approach new onset idiopathic intracranial hypertension (IIH) with someone who has history of systemic lupus erythematosus? Would you consider this to be neuropsychiatric SLE (NPSLE) manifesting as IIH?
How do you approach someone with a history of SLE that has been well controlled for decades on CellCept and Plaquenil, who develops dizziness with a workup concerning for idiopathic intracranial hypertension (IIH), severe transverse sinus stenosis on MRV, empty sella, and elevated opening pressure? APS labs are positive, but otherwise, lupus markers are normal.
What is your approach to treatment? Pulse steroids/escalate to Rituxan/Cytoxan, or treat this as you would an isolated IIH and consider SLE incidental?
Answer from: at Academic Institution
Since there is not a clinical recurrence of lupus, let's assume the disease is quiescent. The patient may have a clotting tendency so extra care should be taken in MRV interpretation. Does the MRV show the smooth-walled flow-related stenoses of intracranial hypertension or is it more consistent with...
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Answer from: at Community Practice
A case like this requires a multidisciplinary approach, especially due to its rarity in SLE patients (IIH due to severe transverse sinus stenosis, TSS).I would consult neurology (e.g., Dr. @Michael Wall who gives an excellent perspective from a neuro-path point of view) but also neurosurgery (for ex...