Symptomatic idiopathic intracranial hypertension triggered by Ramadan intermittent fasting: a case report

ABSTRACT

Background

Idiopathic intracranial hypertension (IIH) is a disorder that primarily affects obese women of reproductive age. The exact pathogenesis of IIH is unknown though multiple etiologies have been proposed.

Case presentation

We report a case of IIH triggered by first-time Ramadan intermittent fasting (RIF) in an 18-year-old woman. Our patient developed new onset headaches, diplopia, and pulsatile tinnitus with examination notable for bilateral papilledema and lumbar puncture revealing an elevated opening pressure. Her symptoms resolved after cessation of RIF, apart from persistent left sided tinnitus which later resolved with acetazolamide administration.

Conclusion

This case report uniquely illustrates that RIF may provoke symptomatic IIH. We hypothesize that a decreased concentration of glucagon-like peptide-1 (GLP-1) induced by fasting results in decreased GLP-1 receptor activation in the choroid plexus, allowing for increased CSF secretion into the ventricles invoking increased intracranial pressure (ICP). This theoretical mechanism provides further insight as to the possible underlying pathophysiology of IIH.

KEYWORDS:

• Idiopathic intracranial hypertension
• headaches
• fasting
• glucagon-like peptide-1
• intracranial pressure
• weight loss
• Ramadan
• migraine

Data availability statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Consent

We have obtained informed consent to publish the details from the affected individual.

Additional information

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Notes on contributors

Ryan Nelson

Ryan Nelson is a Neuromuscular Medicine Fellow at Duke University. He wrote this case report while in training as a Neurology Resident at the University of Florida College of Medicine in Jacksonville, Florida.

S. L. Silliman

S. L. Silliman, M.D., is a University of Florida professor of neurology and a neurologist at the UF Health Neuroscience Institute in Jacksonville specializing in stroke, cerebrovascular disease and multiple sclerosis. He also serves as medical director of the UF Health Comprehensive Stroke Program and program director of the Vascular Neurology Fellowship. Dr. Silliman received his medical degree from Albany Medical College in Albany, New York. He completed residency training in neurology at the Albert Einstein College of Medicine in Bronx, New York, as well as a vascular neurology fellowship at Spaulding Rehabilitation Hospital New England Medical Center in Boston, Massachusetts. Dr. Silliman is board-certified in neurology and vascular neurology.

K. Zarroli

K. Zarroli, M.D., is a University of Florida assistant professor of neurology and a neurologist at the UF Health Neuroscience Institute specializing in clinical neurophysiology and epilepsy. Dr. Zarroli received her medical degree from the Jefferson Medical College of Thomas Jefferson University in Philadelphia, Pennsylvania. She completed an internal medicine internship at the University of Pennsylvania in Philadelphia, and residency training in neurology at Beth Israel Deaconess Medical Center/Harvard Medical School in Boston, Massachusetts. She completed fellowships in neurophysiology and epilepsy at the University of Virginia Medical Center in Charlottesville, Virginia. Dr. Zarroli is board-certified in neurology, clinical neurophysiology, and epilepsy.