Chisholm Jason T, Abou-Jaoude Michelle M, Hessler Amy B, Sudhakar Padmaja
Department of Neurology, University of Kentucky, Lexington, Kentucky, USA.
Department of Ophthalmology, University of Kentucky, Lexington, Kentucky, USA.
Neuroophthalmology. 2017 Sep 1;42(3):169-175. doi: 10.1080/01658107.2017.1367931. eCollection 2018 Jun.
A 24-year-old non-obese, but slightly overweight, female presented with a two-week history of progressive severe headache associated with two days of blurry vision. Clinical exam was significant for bilateral papilledema and an enlarged blind spot on visual field testing. Contrast enhanced MRI head revealed no space occupying lesion. A lumbar puncture revealed an elevated opening pressure of 38 cm HO with normal cerebrospinal fluid composition leading to a diagnosis of pseudotumor cerebri syndrome (PTCS). The patient lacked the typical risk factors of high body mass index or obvious antecedent medications; however, on subsequent questioning, she was chronically ingesting a high vitamin A containing weight loss dietary supplement (Thrive W® - Table 1), which we believe had caused intracranial hypertension. Discontinuation of the diet pill and treatment with acetazolamide led to marked improvement of her PTCS. This case highlights the fact that non-traditional products or medications with high vitamin A may cause pseudotumor cerebri, which treating physicians should assess for while dealing with non-obese PTCS patients.
一名24岁非肥胖但略超重的女性，出现进行性严重头痛两周，伴有视力模糊两天。临床检查发现双侧视乳头水肿，视野测试显示盲点扩大。头颅增强磁共振成像未发现占位性病变。腰椎穿刺显示初压升高至38cm水柱，脑脊液成分正常，诊断为假性脑瘤综合征（PTCS）。该患者缺乏典型的高体重指数或明显的既往用药等危险因素；然而，经后续询问，她长期服用一种富含高维生素A的减肥膳食补充剂（Thrive W® - 表1），我们认为这导致了颅内高压。停用减肥药并使用乙酰唑胺治疗后，她的PTCS有显著改善。该病例突出了这样一个事实，即含高维生素A的非传统产品或药物可能导致假性脑瘤，治疗医生在处理非肥胖PTCS患者时应进行评估。
