Pseudotumor cerebri induced by topical application of steroid: a case report

A 19-year-old man visited the neurology clinic for evaluation of a headache and pulsating tinnitus that he had experienced for 2 months. A neurological examination was normal, except for bilateral disc swelling. His medical history was notable for recently diagnosed psoriasis for which he had been applying topical hydrocortisone 2.5% three to four times a day. Neuro-imaging with a computed tomography scan and magnetic resonance imaging/magnetic resonance venography of the brain was normal, except for tortuosity of the optic nerves and dilatation of the optic nerve sheaths. Pseudotumor cerebri syndrome was suspected. Unfortunately, the patient refused a spinal tap to measure the cerebrospinal fluid opening pressure. Excessive application of topical steroid was believed to be the cause of the patient’s pseudotumor cerebri syndrome. The patient’s headache and disc swelling improved after treatment with acetazolamide and cessation of topical hydrocortisone. This is the first case report of a topical steroid associated with pseudotumor cerebri syndrome.