Pseudotumor cerebri caused by a synthetic vitamin A preparation

Spector, Robert H.; Carlisle, Jeffrey

doi:10.1212/wnl.34.11.1509

Cited by 66 publications

(20 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Multiple case reports found benign intracranial hypertension, or pseudotumor cerebri, characterized by headache, papilledema, and normal CT/MRI and CSF, in children and adults exposed to high levels of vitamin A (Alemayehu 1995;Gerber et al 1954;Gomber and Chellani 1996;Lombaert and Carton 1976;Marie and See 1954;Oliver and Havener 1958;Seigel and Spackman 1972;Selhorst et al 1984;Spector and Carlisle 1984). Selhorst (Selhorst et al 1984) reported that 5/50 patients with "idiopathic" pseudotumor cerebri were found by dietary history to be ingesting large amounts of Vitamin A in their diet.…”

Section: Class Effect: Neuropsychiatric Effects Of Vitamin Amentioning

confidence: 99%

The neurobiology of retinoic acid in affective disorders

Bremner

McCaffery

2008

Progress in Neuro-Psychopharmacology and Biological Psychiatry

144

154

View full text Add to dashboard Cite

Current models of affective disorders implicate alterations in norepinephrine, serotonin, dopamine, and CRF/cortisol; however treatments targeted at these neurotransmitters or hormones have led to imperfect resolution of symptoms, suggesting that the neurobiology of affective disorders is incompletely understood. Until now retinoids have not been considered as possible contributors to affective disorders. Retinoids represent a family of compounds derived from Vitamin A that perform a large number of functions, many via the vitamin A product, retinoic acid. This signaling molecule binds to specific retinoic acid receptors in the brain which, like the glucocorticoid and thyroid hormone receptors, are part of the nuclear receptor superfamily and regulate gene transcription. Research in the field of retinoic acid in the CNS has focused on the developing brain, in part stimulated by the observation that isotretinoin (13-cis retinoic acid), an isomer of retinoic acid used in the treatment of acne, is highly teratogenic for the CNS. More recent work has suggested that retinoic acid may influence the adult brain; animal studies indicated that the administration of isotretinoin is associated with alterations in behavior as well as inhibition of neurogenesis in the hippocampus. Clinical evidence for an association between retinoids and depression includes case reports in the literature, studies of health care databases, and other sources. A preliminary PET study in human subjects showed that isotretinoin was associated with a decrease in orbitofrontal metabolism. Several studies have shown that the molecular components required for retinoic acid signaling are expressed in the adult brain ; the overlap of brain areas implicated in retinoic acid function and stress and depression suggest that retinoids could play a role in affective disorders. This report reviews the evidence in this area and describes several systems that may be targets of retinoic acid and which contribute to the pathophysiology of depression.

show abstract

Section: Class Effect: Neuropsychiatric Effects Of Vitamin Amentioning

confidence: 99%

The neurobiology of retinoic acid in affective disorders

Bremner

McCaffery

2008

Progress in Neuro-Psychopharmacology and Biological Psychiatry

144

154

View full text Add to dashboard Cite

show abstract

“…However, the primary mechanisms of agents known to cause PTC involves the alteration of CSF absorption by effects on either the pressure differential between the central nervous system and venous blood (increasing inflow), or the arachnoid villi (reducing outflow) [36]. The suggested mechanism of ATRA induced PTC is a toxic pathophysiological interaction between vitamin A derivatives and lipid constituents of the choroid plexus and arachnoid villi, resulting in inhibited CSF absorption and an increase in intracranial pressure [37]. Treatment of this condition is necessary to prevent the primary complication, blindness, secondary to progressive optic disc swelling and atrophy [38].…”

Section: Discussionmentioning

confidence: 99%

High Pseudotumor Cerebri Incidence in Tretinoin and Arsenic Treated Acute Promyelocytic Leukemia and the Role of Topiramate After Acetazolamide Failure

Freyer

Smith

Griffiths

et al. 2015

Clinical Lymphoma Myeloma and Leukemia

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

High pseudotumor cerebri incidence in tretinoin and arsenic treated acute promyelocytic leukemia and the role of topiramate after acetazolamide failure

Smith

Griffiths

Thompson

et al. 2014

Leukemia Research Reports

View full text Add to dashboard Cite

Dual differentiation therapy with arsenic trioxide and tretinoin (all-trans-retinoic acid; ATRA) for the management of low and intermediate risk acute promyelocytic leukemia has recently been recommended by the National Comprehensive Cancer Network. Some less common toxicities of the combination may have yet to be fully realized. Of ten patients we have treated thus far, five (50%) have developed pseudotumor cerebri. In one patient, temporary discontinuation of ATRA and initiation of acetazolamide controlled symptoms. In four patients, topiramate was substituted for acetazolamide to relieve symptoms and allow ATRA dose re-escalation. We conclude that providers should monitor for pseudotumor cerebri and consider topiramate if acetazolamide fails.

show abstract

Pseudotumor cerebri caused by a synthetic vitamin A preparation

Abstract: Pseudotumor cerebri developed in a 14-year-old girl with nodulocystic acne, who was taking excessive amounts of a synthetic vitamin A derivative. Although hypervitaminosis A has reportedly caused pseudotumor, Accutane has not previously been implicated.

Cited by 66 publications

References 0 publications

The neurobiology of retinoic acid in affective disorders

The neurobiology of retinoic acid in affective disorders

High Pseudotumor Cerebri Incidence in Tretinoin and Arsenic Treated Acute Promyelocytic Leukemia and the Role of Topiramate After Acetazolamide Failure

High pseudotumor cerebri incidence in tretinoin and arsenic treated acute promyelocytic leukemia and the role of topiramate after acetazolamide failure

Contact Info

Product

Resources

About