Intracranial Hypertension in a Transgender Man.

Objective: Case description of recurrent idiopathic intracranial hypertension (IIH) in a transgender man on gender-affirming hormone therapy. Methods: Case report. Results: A 24-year-old transmasculine patient (assigned female at birth), with a body mass index (BMI) of 37.3, presented with headaches, transient visual obscurations (TVOs), pulsatile tinnitus, Frisén 5 papilledema, and scotomas. He was diagnosed with IIH after normal magnetic resonance imaging (MRI) and magnetic resonance venogram (MRV), an elevated opening pressure of 27 cm water, and normal cerebrospinal fluid studies. IIH resolved with acetazolamide and optic nerve sheath fenestration (ONSF). He then started gender-affirming testosterone therapy and was on this for 20 months when his headaches, pulsatile tinnitus, TVOs, and Frisén 3 papilledema recurred at a BMI of 31. Brain MRI and MRV were normal. Opening pressure was elevated at 31 cm. water. Acetazolamide 4 g/day did not improve the papilledema, thus a left ONSF was repeated resulting in eventual resolution of the IIH. Discussion: Several reports have been published of IIH development in patients receiving testosterone therapy. Hormone prescribers for gender affirmation may wish to screen for visual loss and optic nerve edema in patients undergoing testosterone therapy, which may also stimulate appetite weight gain.

POTS and Antiphospholipid Syndrome: An Unlikely Association.

Antiphospholipid syndrome is a rare complication of postural orthostatic tachycardia syndrome. Clinically, the presentation has overlapping symptoms of both diseases, with lightheadedness or syncope when moving from a supine to a standing position as well as blood clots, headache, or pregnancy complications in women. This case presentation involves a 39-year-old patient identified as female who has been diagnosed with POTS and elevated anticardiolipin antibodies.

Ischemic Stroke Secondary to Stylocarotid Variant of Eagle Syndrome.

Eagle syndrome is a rare cause of stroke and results as a complication of the elongated styloid process (ESP), which can cause carotid dissection and consequent ischemic stroke. We report a case of a 42-year-old woman with a past medical history of rheumatoid arthritis who developed left hemispheric ischemic stroke after deep tissue massage. Imaging studies revealed an intimal tear of the left carotid artery bulb and bilaterally ESPs, measuring approximately 6 cm on the right and 4.5 cm on the left. It seems that direct vascular compromise by the anomalous styloid process was the cause of her carotid artery dissection and stroke. Moreover, neck manipulation may have been a contributing factor.

Management of blood pressure in stroke.

OBJECTIVE: In this review and opinion piece, we discuss recent United States (US)-based guidance statements on the management of BP in stroke according to stroke type and stage of stroke. METHODS: We reviewed the most recent guidance statements on BP control from United States (US)-based organizations such as the American Heart Association/American Stroke Association (AHA/ASA) and American College of Cardiology (ACC), and articles available to the authors in their personal files. RESULTS: The key BP target before starting alteplase (t-PA) is < 185/110 mm Hg, and the maintenance BP after tPA administration is < 180/105 mm Hg. For IPH patients with systolic BP between 150 and 220 mm Hg and no contraindication to acute BP reduction therapy, acute lowering to 140 mm Hg systolic BP is safe. For persons with small vessel or lacunar cerebral ischemia, a reasonable BP lowering target is < 130 mm Hg systolic. For primary stroke prevention, the target BP for those with hypertension is < 140/90 mm Hg and self-measured BP is recommended to assist in BP control. Recent study and guidance suggest a BP target of <130/80 mm Hg for both primary and recurrent stroke prevention. BP control is reasonable for the prevention of cognitive decline or dementia. CONCLUSIONS: BP targets for the proper management of stroke vary by chronological stage of stroke and by stroke subtype. Furthermore, consideration should be given to control of BP variability, especially in the acute phases of stroke, as it may play a role in conferring longer term outcomes.