Background: Intravenous immunglobulin (IVIG) is a well established treatment of Chronic Inflammatory Demyelinating Polyneuropathy (CIDP). There are well recognised complications of IVIG therapy including transfusion reactions, hypertension and headache. Intracranial hypertension is not reported as a side effect of IVIG. We report a case of CIDP treated with IVIG with subsequent development of intracranial hypertension.

Case:

An 11 year old girl presented with a 4 week history of increasing walking difficulty and altered sensation. Raised CSF protein with no increase in leukocytes and neurophysiology changes of polyneuropathy suggested the diagnosis of CIDP. Treatment with IVIG was given at 2g/kg over 2 days. There was a rapid improvement in symptoms over the following week; with an improvement in mobility and pain. over the following 3 weeks the patient developed severe headache and visual disturbance. Examination showed bilateral 6th nerve palsy and papilloedema. Lumbar puncture confirmed CSF pressure of >40cm H2O. She was treated with acetazolamide and gradually improved. SHe then had a recurrence of weakness an walking difficulty 6 weeks later. IVIG treatment was repeated, again with good resolution of symptoms but subsequent recurrence of Intracranial hypertension. Further relapse after 8 weeks was treated with iv Methylprednisone with a good effect.

Discussion:

IVIG is a well established and effective therapy for CIDP. There are well recognised adverse effects. Iatrogenic intracranial hypertension without venous sinus thrombosis is not widely reported. This case demonstrates this unusual problem which offers a dilemma in treatment.