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Old 04-04-2011
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Neuro Neurology case scenario question

A 25 year old lady who has been having difficult time spliting with her partner, put on weight as a result of comfort eating, presented to emergency department with 2 weeks history of nausea and headache which is worse in the morning. She is fit and well otherwise apart from taking isotretinoin for acne. Clinically she looks well, afebrile, hemodynamically stable and no focal neurology. CT brain is within normal limit. This is her fundus. The most appropriate treatment plan should be

A) Reassure, simple analgesics and psychiatrist review if remain symptomatic
B) Analgesics, anti-emetics and sumatriptan
C) Stop isotretinoin
D) Proceed with MR and surgery


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Arrow C) Stop isotretinoin

My ans is C) Stop isotretinoin

Vitamin A is an essential vitamin in synthesis of CSF. Vit. A intoxication will cause too much production of CSF result in increase intracranial pressure. I see the papilledema around the optic disc (on fundoscopy). Papilledema usually caused by increase in intracranial pressure.

http://jn.nutrition.org/content/104/4/478.full.pdf
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Old 04-04-2011
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Default hmmm

C. I think, for all the reasons I can think of...what was mentionedin regards to ICP and including the fact that she is 25, fertile, and now gain weight, nausea, vomiting... stop teratogen just incase, and check HCG...so one way or another
C.
Excellent question, thank you for posting it...can't wait to see the answer
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most probabbly its Pseudotumor cerebri AKA idipathic intracranial hypertension,
right age bracket(young female),pappiledema and Vit A use(which is very strong risk factor along with tetracycline) fits quite well------>next best step in Mx SHOULD BE stop isotretinoin option C
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Yes. You all are right.

This is the typical case of isotretinoin related intracranial hypertension.

Papilledema in young obese women, remember pseudotumor cerebri or benign intracranial hypertension as the possibility!

Other associated drugs are-nalidixic acid, danazol (Danocrine), and corticosteroid withdrawal and with systemic disorders such as hypoparathyroidism and lupus.

After eliminating secondary causes of IIH, the following steps should be considered in terms of treatment-

1. dietary counseling for weight loss
2. carbonic anhydrase inhibitors (acetazolamide) and corticosteroids have proved useful in headache control
3. second-line agent, furosemide also acts to lower CSF production
4. Serial lumbar punctures are understandably unpopular with patients even though transient headache relief is obtained
5. CSF shunting procedures (ventriculoperitoneal shunt) are occasionally necessary



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Show Teeth thank you

Awesome, thanks for the explanation
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