All-Trans Retinoic Acid-Induced Pseudotumor Cerebri during Induction Therapy for Acute Promyelocytic Leukemia: A Case Report and Literature Review

Table 1

Modified Dandy criteria for diagnosis of pseudotumor cerebri [16].

(1) If symptoms and signs are present, they may only reflect those of generalized intracranial hypertension or papilledema.
The most common symptoms reflecting generalized intracranial hypertension are headache, pulsatile intracranial noises, and double vision. Symptoms reflecting papilledema include transient visual obscurations and peripheral visual loss.
(2) Elevated intracranial pressure must be documented with the patient lying in the lateral decubitus position.
A lumbar CSF opening pressure greater than 250 mm H2O is indicative of this disorder. Readings between 200 mm and 250 mm H2O are nondiagnostic.
(3) CSF must be normal.
There must be no evidence of pleocytosis, cellular atypia, or hypoglycorrhachia, and CSF protein levels should be normal.
(4) There must be no evidence of hydrocephalus, mass, structural, or vascular lesion on MRI or contrast-enhanced CT for typical patients and on an MRI and MR venography for atypical patients.
VST is rare in typical patients (i.e., an obese woman of childbearing age). Therefore, a CT is sufficient even though it cannot detect VST. The incidence of VST and other vascular lesions increases significantly in atypical patients. Consequently, an MRI or MR venography scan is warranted given their heightened ability at detecting these differential disorders.
(5) No other cause of pseudotumor cerebri can be identified.
CSF; cerebral spinal fluid; MRI; magnetic resonance imaging; CT; computerized tomogram; and VST; venous sinus thrombosis.