Yu Caberry W, Kwok Jason M, Micieli Jonathan A
School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.
Department of Ophthalmology of Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
BMJ Case Rep. 2019 Nov 19;12(11):e232725. doi: 10.1136/bcr-2019-232725.
Use of medications including vitamin A derivatives and tetracyclines have been associated with papilledema and raised intracranial pressure. A 46-year-old woman was referred to neuro-ophthalmology for bilateral optic disc oedema and had a 7-year history of cyclosporine use after renal transplantation. She had preserved visual function and moderate bilateral optic disc oedema. Magnetic resonance imaging and magnetic resonance venography of the brain were normal apart from signs of raised intracranial pressure. Lumbar puncture revealed an elevated opening pressure of 40 cm of water with normal cerebrospinal fluid contents. Nephrology was consulted and cyclosporine was switched to tacrolimus and she was treated with acetazolamide. The papilledema resolved within 1 month of her initial visit. It is important to recognise the role that cyclosporine plays in raising intracranial pressure, especially in patients requiring immunosuppression, such as transplant patients. Tacrolimus is a suitable alternative in these cases.
使用包括维生素A衍生物和四环素在内的药物与视乳头水肿和颅内压升高有关。一名46岁女性因双侧视盘水肿被转诊至神经眼科，她在肾移植后有7年使用环孢素的病史。她的视力功能保留，双侧视盘有中度水肿。脑部磁共振成像和磁共振静脉造影除了有颅内压升高的迹象外均正常。腰椎穿刺显示初压升高至40厘米水柱，脑脊液成分正常。咨询了肾病科，将环孢素换成了他克莫司，并给予她乙酰唑胺治疗。视乳头水肿在她首次就诊后1个月内消退。认识到环孢素在升高颅内压中所起的作用很重要，尤其是在需要免疫抑制的患者中，如移植患者。在这些情况下，他克莫司是合适的替代药物。
