BMJ 2001;323:694 ( 22 September )

Letters

Intracranial hypertension and nasal fluticasone propionate

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EDITOR---Bond et al said that nasal fluticasone propionate caused benign intracranial hypertension in a 13 year old boy with a history of Crohn's disease and subsequently reported this to the Committee on Safety of Medicines.1 We have numerous problems with this hypothesis. Firstly, Bond et al did not confirm the diagnosis of intracranial hypertension as the cerebrospinal fluid pressure, which should be markedly raised, was not measured on any occasion.2 Their conclusions can thus at best be based only on papilloedema, headache, and backache.

The boy was seen by specialists from the ear, nose, and throat department, but no mention was made of the presence or absence of the otological manifestations, which include objective pulsatile tinnitus and low frequency hearing loss, which can be the major or only manifestation of this syndrome.3 Other recognised associated conditions were not excluded, such as hypervitaminosis A, systemic lupus erythromatosis, hypothyroidism and its . . . [Full text of this article]
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