Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Neurocrit Care. 2018 Dec;29(3):504-507. doi: 10.1007/s12028-017-0473-9.
The use of weight loss drugs and dietary supplements is common, but safety profiles for these drugs are largely unknown. Reports of toxicity have been published, and the use of these agents should be considered in clinical differential diagnoses.
We report the case of a patient with toxic leukoencephalopathy and hyponatremia associated with oral consumption of a thermogenic dietary supplement and essential oils.
A 30-year-old woman presented after 2 days of headache, blurred vision, photophobia, vomiting, and hand spasms. She was taking a thermogenic dietary supplement daily for 6 months as well as a number of essential oils. Examination revealed mild right sided ataxia and diffuse hyperreflexia. Neuroimaging demonstrated bilaterally symmetric T2 hyperintensities of the corpus callosum and periventricular white matter. Approximately 18 h after admission she became unresponsive with brief extensor posturing and urinary incontinence. She partially recovered, but 1 h later became unresponsive with dilated nonreactive pupils and extensor posturing (central herniation syndrome). She was intubated, hyperventilated, and given hyperosmotic therapy. Emergent imaging showed diffuse cerebral edema. Intracranial pressure was elevated but normalized with treatment; she regained consciousness the following day. She was extubated one day later and discharged on hospital day 5. She was seen 2 months later with no further symptoms and a normal neurologic examination.
The pathophysiology of this patient's hyponatremia and toxic leukoencephalopathy is unknown. However, physicians must be aware of the association between thermogenic dietary supplements and toxic leukoencephalopathy. Vigilance for life-threatening complications including hyponatremia and cerebral edema is critical.
减肥药物和膳食补充剂的使用很常见，但这些药物的安全性概况在很大程度上尚不清楚。已经有关于毒性的报道，应在临床鉴别诊断中考虑使用这些药物。
我们报告了一例与口服发热性膳食补充剂和精油有关的中毒性脑白质病和低钠血症患者。
一名 30 岁女性在头痛、视力模糊、畏光、呕吐和手部痉挛 2 天后就诊。她每天服用一种发热性膳食补充剂，并且还服用了多种精油。检查发现轻度右侧共济失调和弥漫性反射亢进。神经影像学显示双侧对称的胼胝体和脑室周围白质 T2 高信号。入院后约 18 小时，她变得无反应，伴有短暂的伸肌姿势和尿失禁。她部分恢复，但 1 小时后，她变得无反应，瞳孔扩大且无反应，伴有伸肌姿势（中央疝综合征）。她被插管、过度通气并给予高渗治疗。紧急成像显示弥漫性脑水肿。颅内压升高，但治疗后正常；她于次日恢复意识。一天后她被拔管，住院第 5 天出院。2 个月后，她再次就诊，没有进一步的症状，神经系统检查正常。
该患者低钠血症和中毒性脑白质病的病理生理学尚不清楚。然而，医生必须意识到发热性膳食补充剂与中毒性脑白质病之间的关联。警惕包括低钠血症和脑水肿在内的危及生命的并发症至关重要。
