Department of Intensive Care, Academic Medical Center, University of Amsterdam, Meibergdreef 19, Amsterdam NL-1100 DD, the Netherlands.
Crit Care. 2011;15(1):R64. doi: 10.1186/cc10040. Epub 2011 Feb 18.
A 49-year-old woman was admitted to our hospital because of thunderclap headache and blurred vision. At the time of presentation, her blood pressure was 219/100 mmHg, her arterial pH was 7.64 and her potassium level was 2.7 mM/l.
The combination of sequential computed tomography (CT) and the triad of hypertension, hypokalemia and metabolic alkalosis in this patient suggested the diagnosis. Supplementary anamnesis and long-term follow-up confirmed it.
Brain computed tomography imaging showed minor bleeding in the left Sylvian fissure and bilateral occipital edema, suggestive of posterior reversible encephalopathy syndrome (PRES). Repeated brain CT after 10 days showed a complete resolution of radiological signs. The patient informed us that she had quit smoking 2 weeks ago and had started consuming large amounts of licorice instead of smoking. After she abandoned licorice consumption, her blood pressure normalized. Her latest blood pressure reading was 106/60 mmHg without the use of any antihypertensive drugs.
To the best of our knowledge, this is the first case report describing licorice consumption as a cause of PRES. Glycyrrhizic acid, a component of licorice, inhibits 11β-hydroxysteroid dehydrogenase and subsequently causes mineralocorticoid excess. Mineralocorticoid excess in turn causes high blood pressure and ultimately gives rise to malignant hypertension. Physicians should remember that licorice use is a very easy-to-treat cause of hypertension, hypertensive encephalopathy and PRES.
一名 49 岁女性因突发头痛和视力模糊而被收入我院。就诊时，其血压为 219/100mmHg，动脉 pH 值为 7.64，血钾水平为 2.7mM/l。
该患者的连续计算机断层扫描（CT）结果和高血压、低钾血症及代谢性碱中毒三联征提示了诊断。补充病史和长期随访证实了这一诊断。
脑 CT 成像显示左侧大脑外侧裂和双侧枕叶水肿有轻微出血，提示为后部可逆性脑病综合征（PRES）。10 天后重复脑部 CT 显示影像学征象完全消退。患者告知我们她已经在 2 周前戒烟，开始大量食用甘草代替吸烟。停止食用甘草后，她的血压恢复正常。她最近的血压读数为 106/60mmHg，未使用任何降压药物。
据我们所知，这是首例描述甘草摄入为 PRES 病因的病例报告。甘草中的甘草酸抑制 11β-羟类固醇脱氢酶，进而导致盐皮质激素过多。盐皮质激素过多反过来导致高血压，最终导致恶性高血压。医生应记住，甘草的使用是一种非常容易治疗的高血压、高血压脑病和 PRES 的病因。
