JOBNAME: No Job Name PAGE: 1 SESS: 15 OUTPUT: Thu Nov 8 18:53:47 2007 SUM: 8E4EFFF1 /v2451/blackwell/journals/hed_v0_i0/hed_992_ Clinical Notes Drug Induced Intracranial Hypertension Associated with Sulphasalazine Treatment Eser Sevgi; Gul Yalcin; Tulay Kansu; Kubilay Varli A 25-year-old woman patient developed headache and papilledema under sulphasalazine treatment for ulcerative colitis. The patient met the International Headache Society’s criteria for idiopathic intracranial hypertension. Sulphasalazine was discontinued and the patient was given azathioprine for ulcerative colitis and acetazolamide for intracranial hypertension. Three weeks later, her examination was normal and lumbar puncture revealed an opening pressure of 180-mm H2O. Sulphasala- zine is a product of 5 aminosalicylate (5 ASA) and there seems to be a relationship between the administration of sulphasalazine and the onset of intracranial hypertension symptoms. Early diagnosis of intracranial hypertension is important in patients with ulcerative colitis receiving 5 ASA treatment to prevent visual complications. Key words: idiopathic intracranial hypertension, sulphasalazine, ulcerative colitis (Headache 2007;••:••-••) INTRODUCTION Idiopathic intracranial hypertension (IIH) is a syndrome of raised intracranial pressure in the absence of an intracranial mass lesion or cerebrospi- nal outflow obstruction. IIH is a secondary headache disorder characterized by headaches and visual symp- toms. 1 It most frequently occurs in obese women of childbearing age; however, many secondary causes exist and it may affect children, men, and slim indi- viduals. Prompt recognition, evaluation, and treat- ment are needed to prevent permanent visual loss. With the exception of papilledema and sixth nerve palsy, the neurological examination is normal. Other cranial nerve palsies may occur occasionally. 2 Although the cause is largely unknown, several medi- cations have been associated with IIH. 3 Two cases of IIH reported in the literature have been associated with mesalasine treatment, which is a product of 5 aminosalicylate (5 ASA). 4,5 Sulfapyridine bound to 5 ASA is named as sulphasalazine. Here, we present a woman who developed IIH under sulphasalazine treatment for ulcerative colitis. CASE REPORT A 25-year-old woman patient was admitted to the hospital with the complaint of headache and blurred vision. She had been put on sulphasalazine treat- ment (2000 milligrams per day) for ulcerative colitis 3 weeks previously. Neurological examination revealed 20/200 visual acuity on both sides with the near card, peripheral constriction in visual fields, bilat- eral papilledema (Fig. A), abduction deficit, and peripheral facial palsy on the left. The motor and sensory examinations were normal with no meningeal From the Hacettepe University Faculty of Medicine, Depart- ment of Neurology, Ankara, Turkey. Address all correspondence to •• Eser Basak Sevgi, Hacettepe University Hospitals, Department of Neurology, 06100 Sıhhıye, Ankara, Turkey. Accepted for publication August 28, 2007. Conflict of Interest: None ISSN 0017-8748 doi: 10.1111/j.1526-4610.2007.00992.x Published by Blackwell Publishing Headache © 2007 the Authors Journal compilation © 2007 American Headache Society 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 1 1 2