Pseudo tumor cerebri is caused by?
Correct Answer: Vitamin A excess
Description: ANSWER: (A) Vitamin A excessREF: Harrison's 18th ed ch: 14Idiopathic intracranial hypertension (IIH) or pseudotumor cerebri or benign intracranial hypertension is a disorder of unknown etiology that predominantly affects obese women of childbearing age.iavascriprishowrefcontentrrefrenceslayer'); The primary problem is chronically elevated intracranial pressure (ICP), and the most important neurologic manifestation is papilledema, which may lead to progressive optic atrophy and blindness. Although IIH, pseudotumor cerebri, and benign intracranial hypertension (BIH) are synonymous, IIH is the preferred term.CausesDrugs: Amiodarone, antibiotics (eg, nalidixic acid, penicillin, and tetracycline), carbidopa, levodopa, chlordecone, corticosteroids (topical and systemic), cyclosporine, danazol, growth hormone, indomethacin, ketoprofen, lead, leuprolide acetate, levonorgestrel implants, lithium, oral contraceptives, oxytocin, perhexiline, phenytoin, and vitamin A (> 100,000 U/day)/retinoic addSystemic diseases:Familial Mediterranean feverHypertensionAnemiaMultiple sclerosisPolyangiitis overlap syndromePsittacosisChronic renal diseaseReye syndromeSarcoidosisSystemic lupus erythematosusThrombocytopenic purpuraChronic respiratory insufficiencyCompression of cerebral veins by extravascular tumors, secondary thrombosis due to coagulopathy, or relative stenosis due to a venous flow anomaly can result in impaired absorption of CSF and, thus, IIH.Restriction of venous drainage from the head may be impaired with radical neck dissection, even if it is completed only on the right (drainage from the head takes place mainly via the right jugular vein).Endocrine risk factorsFemale sexReproductive age groupMenstrual irregularityObesityRecent weight gainAdrenal insufficiencyCushing diseaseHypoparathyroidismHypothyroidismExcessive thyroxine replacement in children (ie, low thyrotropin levels)TREATMENT:Acetazolamide appears to be the most effective agent for lowering ICPIn the event of intolerance to acetazolamide, furosemide may be used as a replacement diureticHeadache prophylaxis: headaches can often be controlled with amitriptyline, propranolol, or other commonly prescribed migraine prophylaxis agents. Topiramate is also an excellent choice, in that one of its side effects is weight lossCorticosteroids are effective in lowering ICP in patients whose IIH has an inflammatory etiology. In addition, they may be used as a supplement to acetazolamide to hasten recovery in patients who present with severe papilledema. Because of their significant adverse effects, corticosteroids should not be considered as a long-term solution for IIH patients.
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