Pseudotumor cerebri (toxic effect of the "magic bullet")

A 10 year-old female patient presented to the outpatient unit of the ophthalmology department of Menelik II Hospital with complaints of inward deviation of the left eye, of three weeks' duration. The patient was on a mega dose of vitamin A 200,000 I.U. (the "magic bullet") daily for two months prior to the onset of the present illness. Physical examination revealed left sixth nerve palsy and bilateral papilloedema in an alert and oriented patient without localizing neurologic findings. The cerebrospinal fluid pressure ( > 250 mm water) was increased and skull X-ray findings were suggestive of increased intracranial pressure (IIP). This case meets the modified Dandy criteria except that a highly likely cause, hypervitaminosis A, is associated. Therefore, a diagnosis of Idiopathic Intracranial Hypertension (IIH) or Pseudotumor Cerebri was made. This disorder and its management is discussed and literature reviewed. The serious and potentially blinding toxic effect of Vitamin A, if consumed in excessive amounts, is emphasized.