Intracranial hypertension associated with arthroprosthetic cobaltism?

PURPOSE: The purpose of this case report was to detail a unique patient with proven systemic cobaltism from metal-on-metal prosthetic hip articulation who then presented with clinical and radiographic signs of increased intracranial pressure. OBSERVATIONS: A 59-year-old man with a past medical history of degenerative joint disease of the hip that status post total hip arthroplasty with cobalt-chromium implant presented with clinical and radiographic signs of increased intracranial hypertension. He underwent a revision arthroplasty with local debridement and removal of the cobalt-chromium implant and his serum cobalt level was elevated at 0.9 microg/L (normal range 0.1–0.4microg/L). One year after removal of the implant, the patient was asymptomatic and stable on acetazolamide. CONCLUSIONS: To our knowledge, this is the first such report in the English literature to associate increased intracranial hypertension with systemic cobaltism, and publication of this case report would make clinicians aware of the potential neurologic and neuro-ophthalmic presentation of metal-on-metal orthopedic prosthetics.