Idiopathic or Secondary?

Fulminant idiopathic intracranial hypertension (FIIH) is a subtype of idiopathic intracranial hypertension (IIH) characterized by rapid, severe, progressive vision loss. Surgical intervention is often performed either as a cerebrospinal fluid (CSF) shunt procedure or an optic nerve sheath fenestration or, at times, both. These surgical procedures carry a significant risk of morbidity and failure. We present 2 patients in whom a temporary lumbar drain was successfully used in the management of medically undertreated pediatric FIIH, and circumvented the need for surgical intervention.

Letters to the Editor consequences to the patient through toxic impurities and microbial contamination. Samuel P. Burke, BA Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida Amanda D. Henderson, MD Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida Division of Neuro-Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland Idiopathic or Secondary? I read with interest the clinical observation by Mohammad et al (1) of "idiopathic intracranial hypertension" associated with the topical application of vitamin A. Whether or not one has abandoned the term "idiopathic intracranial hypertension" for the term "primary pseudotumor cerebri," as recommended by De Simone et al (2), it would seem to me that this case does not fall under the rubric of "idiopathic" as it has at least a presumed etiology, that is, vitamin A, and would be better termed "secondary pseudotumor cerebri." Diagnosing Chronic Lymphocytic Leukemia With Temporal Artery Biopsy W e read with interest the report of Ghinai et al (1) documenting how the diagnosis of light-chain amyloidosis was established with temporal artery biopsy in a patient suspected of having giant cell arteritis (GCA). We would like to share our experience with a patient in whom temporal artery biopsy ultimately led the diagnosis of chronic lymphocytic leukemia. A 74-year-old man developed acute painless vision loss in his left eye. On examination, visual acuity was 20/20, right eye and 20/40, left eye with diminished color vision in the left eye and a left relative afferent pupillary defect. The remainder of the ophthalmic examination was normal. The patient's blood pressure was 123/86 mm Hg. Normal laboratory testing including erythrocyte sedimentation rate Letters to the Editor: J Neuro-Ophthalmol 2017; 37: 216-221 Byron L. Lam, MD Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, Florida The authors report no conflicts of interest. REFERENCES 1. Ragam A, Agemy SA, Dave SB, Khorsandi AS, Banik R. Ipsilateral ophthalmic and cerebral infarctions following cosmetic polylactic acid injection into the forehead. J Neuroophthal. 2017;37:77-80. 2. Carle MV, Roe R, Novack R, Boyer DS. Cosmetic facial fillers and severe vision loss. JAMA Ophthalmol. 2014;132:637-639. 3. Houseman ND, Taylor GI, Pan WR. The angiosomes of the head and neck: anatomic study and clinical applications. Plast Reconstr Surg. 2000;105:2287-2313. 4. Matthews KR, Iltis AS. Unproven stem cell-based interventions and achieving a compromise policy among the multiple stakeholders. BMC Med Ethics. 2015; 16:75. Neil R. Miller, MD, FACS Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland The author reports no conflicts of interest. REFERENCES 1. Mohammad YM, Raslan IR, Al-Hussain FA. Idiopathic intracranial hypertension induced by topical application of vitamin A. J Neuroophthalmol. 2016;36:412-413. 2. De Simone R, Ranieri A, Montella S, Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology. 2014;82:1011-1012. (4 mm/h), platelet count, glucose, cholesterol, and triglycerides. Leukocyte count was 12.6 · 109 cells/L (normal range: 3.5 2 10.0 · 109 cells/L). Echocardiography and ultrasonography of the carotid arteries were unremarkable. Two months later, the patient complained of visual field loss in the right eye although visual field testing was unremarkable in that eye. There was an inferior altitudinal defect in the left eye. Six months after his initial visual complaints, the patient reported acute, painless loss of vision in his right eye. Acuity was counting fingers, right eye and 20/30, left eye with a right relative afferent pupillary defect. The right fundus was normal and there was mild left optic disc pallor. The right visual field demonstrated central and inferior loss, whereas the left field was normal. Repeat testing including erythrocyte sedimentation rate, C-reactive protein, and platelet count was normal. A temporal artery biopsy was performed. There were no findings suggestive of GCA but, 217 Copyright © North American Neuro-Ophthalmology Society. Unauthorized reproduction of this article is prohibited.