Case Report: An IIH Induced Endometriosis that Diagnosed by OCT, and Revealed Ten Years Dilemma of HPG Axis Dysfunction due to Pressure Effect of CSF on Pituitary Stalk

Bita Shalbafan, Seyed Kianoosh Naghibzadeh, Hajar Aminzadeh, Hossein Lanjanian, Bardia D Baloutch, Katayon Berjis, Hamid Sajjadi
In: Mathews Journal of Neurology · 2023 · vol. 7(1) · doi:10.30654/mjn.10023 · W4327518082
article OA: diamond CC0 ⤵ 1 in-corpus citation
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Abstract

A 50 years old female patient stepped into Neurology practice, who had been suffering from intractable headaches and followed up for 10 years.At the meantime, she was secondarily assessed by Endometriosis stage-II.Meanwhile, the lab workup did not reflect much of an off the chart hormonal study, Anemia was a point of consideration.Although treatment for Anemia was successfully fulfilled, no progression was noted with mending Endometriosis symptoms and headaches.To that end, the patient was referred to Neurologist.She underwent a brain MRI study and was reported by empty Sella as an incidental finding.As a result, fundus photography was performed to check for papilledema, where no significant findings were reported.However, thus Empty Sella was in combination with severe headaches, Optical Coherence Tomography (OCT) was employed to have a closer look into her Optic Disc.OCT findings of the Retinal Nerve Fiber Layer (RNFL) over the Circumpapillary Tomogram and choroidal folds, concluded a micro-papilledema that finally provided an explanation for those chronic headaches.To that end, the patient went through a Lumber Puncture (LP), where an intracranial pressure (ICP) of 29 cmH2O was measured, CSF exam showed no cells and so normal Biochemical analysis.She was eke prescribed by Acetazolamide and constantly studied through the OCT, in order to

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