Journal of Neuro-Ophthalmology:
Letters to the Editor
Department of Ophthalmology University of Florida Gainesville Gainesville, Florida firstname.lastname@example.org
We report a case of idiopathic intracranial hypertension (IIH) in a transgender man. To our knowledge, no such case has been described previously.
A 33-year-old man presented to the neuro-ophthalmology clinic at the University of Florida in January 2007. He was complaining of headaches and blurred vision. IIH had been diagnosed 8 months earlier, and he was treated with 1,500 mg/day acetazolamide. He reported being a transgender woman-to-man who had undergone bilateral mastectomies and testosterone treatment that had been discontinued 18 months earlier.
Our examination disclosed a patient who weighed 168 lbs with height of 5 feet 3 inches. Blood pressure was 118/72 mm Hg with a pulse of 84/min. Best-corrected visual acuities were 20/15 in each eye. Color vision was normal by Ishihara plate testing. Ophthalmoscopy showed optic disc edema in both eyes (Fig. 1). Humphrey visual fields showed nerve fiber bundle defects and enlarged blind spots in both eyes (Fig. 2). Results of a CT angiogram with attention to the venous phase was normal. A lumbar puncture disclosed an opening pressure of 300 mm H2O with normal constituents.
Because of side effects from acetazolamide, 80 mg/day furosemide was substituted for acetazolamide. For headache control, he was treated with 150 mg/day topiramate. On a follow-up 1 month later, visual field defects had improved. However, 2 months later, the visual field defects worsened, and he underwent an optic nerve fenestration in the right eye. One week postoperatively, visual field defects had improved in the left eye, but the right eye remained stable. On month later, visual field defects had improved in both eyes.
IIH is found most commonly in overweight women in their reproductive years. It may also be caused by dural sinus thrombosis (5,6), a reduction in corticosteroid therapy, or hormonal imbalance (7-10), vitamin A, anabolic corticosteroids, tetracycline, lithium, and pregnancy (11-13). Our patient had prior use of testosterone. Despite the availability of transgender medicine for decades, we were unable to find a published report of IHH in patients who change gender.
Clinton Sheets, MD
Marc Peden, MD
John Guy, MD
Department of Ophthalmology University of Florida Gainesville, Florida email@example.com
1. Lee AG, Brazis PW. Case studies in neuro-ophthalmology for the neurologist. Neurol Clin
2. Binder DK, Horton JC, Lawton MT, et al. Idiopathic intracranial hypertension. Neurosurgery 2004;54:538-51.
3. Friedman DI, Jacobson DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology
4. Banik R, Lin D, Miller NR. Prevalence of Chiari I malformation and cerebellar ectopia in patients with pseudotumor cerebri. J Neurol Sci
5. Friedman DI. Cerebral venous pressure, intra-abdominal pressure, and dural venous sinus stenting in idiopathic intracranial hypertension. J Neuroophthalmol
6. Lin A, Foroozan R, Danesh-Meyer HV, et al. Occurrence of cerebral venous sinus thrombosis in patients with presumed idiopathic intracranial hypertension. Ophthalmology
7. Balasubramanian S, Shivbalan S, Ganesh R. Pseudotumor cerebri following oral betamethasone for common cold. Indian J Pediatr
8. Toscano V, Sancesario G, Bianchi P. Cerebrospinal fluid estrone in pseudotumor cerebri: a change in cerebral steroid hormone metabolism? J Endocrinol Invest
9. Donaldson JO, Binstock ML. Pseudotumor cerebri in an obese woman with Turner syndrome. Neurology
10. Stiebel-Kalish H, Kalish Y, Lusky M, et al. Puberty as a risk factor for less favorable visual outcome in idiopathic intracranial hypertension. Am J Ophthalmol
11. Tang RA, Dorotheo EU, Schiffman JS, et al. Medical and surgical management of idiopathic intracranial hypertension in pregnancy. Curr Neurol Neurosci Rep
12. Lee AG, Pless M, Falardeau J, et al. The use of acetazolamide in idiopathic intracranial hypertension during pregnancy. Am J Ophthalmol
13. Bagga R, Jain V, Das CP, et al. Choice of therapy and mode of delivery in idiopathic intracranial hypertension during pregnancy. MedGenMed
14. Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender persons: the influence of gender-based discrimination and victimization. J Homosex
15. Gorton RN. Health care and insurance issues for transgender persons. Am Fam Physician
16. Newfield E, Hart S, Dibble S, et al. Female-to-male transgender quality of life. Qual Life Res
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