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2022 Mar 13

Br J Clin Pharmacol

Pseudotumor cerebri due to Phenytoin in a child.


Pillai S S, Riyaz A, Krishnan C, Gireesh S N
Br J Clin Pharmacol. 2022 Mar 13.
PMID: 35285056.


Pseudotumor cerebri is a manifestation of intracranial hypertension in an otherwise normal individual. We hereby report phenytoin induced pseudotumor cerebri in a nine-year-old boy who received the same as a prophylactic anticonvulsant following surgical removal of unifocal Langerhans cell histiocytosis involving the right frontal bone. The child was evaluated for headache and diplopia after starting phenytoin and on evaluation was found to have bilateral sixth nerve palsy. The only abnormality detected was an elevated cerebrospinal fluid pressure. Withdrawal of phenytoin resulted in complete resolution of symptoms. Despite meticulous literature search, we came across only one other report of phenytoin induced pseudotumor cerebri. We report this case to highlight the need to consider this entity whenever a patient presents with new onset or persistent headache and visual symptoms soon after starting a medication since a high degree of suspicion is needed to arrive at the diagnosis and to take appropriate steps before it progresses to very harmful complications like vision loss.