Micronutrients and IIH – A case series

Pseudotumor cerebri (PTC) or idiopathic intracranial hypertension (IIH) is described as a syndrome of headache, papilloedema and elevated pressure of the cerebrospinal fluid (CSF) beyond 200-mm H2O, normal neuroimaging and normal neurological examination in the presence of normal CSF composition. It is nearly always bilateral. PTC may be either primary or secondary to some conditions. Secondary causes of PTC may include some medications, endocrine abnormalities, autoimmune disorders, cranial venous outflow abnormalities and anaemia. Here, we report two cases of IIH, one due to vitamin B12 deficiency and other due to hypervitaminosis of vitamin A. Both the cases had anaemia. Exact pathogenesis for increase in intracranial pressure is obscure. Various mechanisms proposed in literature include increased cerebral venous pressure secondary to a relative hyperviscosity state and altered cerebral hemodynamics due to tissue hypoxia which increases brain capillary permeability and therefore causes raised ICP, ultimately leading to papilloedema. Early suspicion and prompt initiation of treatment help in preventing irreversible loss of vision in these patients.