Idiopathic intracranial hypertension associated with iron deficiency anaemia: a lesson for management.

AIM: To document the causal association of iron deficiency anaemia (IDA) and intracranial hypertension (IH). METHODS: A consecutive case note review of patients with a clinical diagnosis of idiopathic intracranial hypertension (IIH) and anaemia presenting to a tertiary referral unit over a 2.5-year period. Demographics, aetiology and clinical details were recorded and analysed. RESULTS: Eight cases were identified from 77 new cases presenting with IIH. All 8 had documented microcytic anaemia with clinical evidence of raised intracranial pressure. There was no evidence of venous sinus thrombosis on MRI and MR venography in 7 subjects and on repeated CT venography in 1. On correction of anaemia alone, 7 cases resolved. One patient with severe progressive visual loss underwent ventriculoperitoneal shunt in addition to treatment of anaemia, with good outcome. The incidence of this association is 10.3%. CONCLUSION: These cases present an association between IDA and IH, in the absence of cerebral sinus thrombosis. As a clinically significant proportion of cases presenting with signs of IIH have IDA, we recommend all patients presenting with IIH have full blood counts and if they are found to be anaemic, they should be treated appropriately.

Medpor porous polyethylene implants in orbital blowout fracture repair.

PURPOSE: Various materials are used in orbital blowout fracture repair. We describe a series of patients with orbital blowout fractures that were repaired using porous polyethylene (Medpor) sheets. METHODS: A non-comparative interventional case series is described of 30 blowout fractures of 30 patients aged 7-60 years (median 29 years) who underwent orbital blowout fracture repair with Medpor sheets. The mean follow-up was 19.1 months (minimum 5 months). The indication for surgery in 6 cases was non-resolving diplopia. The remaining 24 cases had surgery for enophthalmos. Ten cases underwent primary or secondary hydroxyapatite orbital implantation at the same time as orbital floor blowout fracture repair. Data were collected on postoperative motility and diplopia, enophthalmos, cosmesis, complications and re-operations. RESULTS: In no case was diplopia worsened by blowout fracture repair. Where surgery was performed for the correction of enophthalmos, late surgery did not compromise the surgical results. There were no intraoperative complications. The one major complication was a case of recurrent implant infections leading to implant removal. There were 3 minor postoperative complications: 2 cases of postoperative infraorbital anaesthesia and one case of a palpable titanium screw. Re-operations were performed for pre-existent diplopia, lid laxity, socket abnormalities and mid-facial deformities. None of these arose from the blowout fracture repair. CONCLUSIONS: The study suggests that in orbital blowout fracture repair Medpor implants are safe and effective with few complications. Late surgery for enophthalmos is technically more difficult but is not associated with poorer functional or cosmetic results.