Micronutrient Deficiencies Presenting with Optic Disc Swelling Associated with or without Intracranial Hypertension: A Systematic Review

Abstract

Idiopathic intracranial hypertension (IIH) is a neurological disorder characterised by optic disc swelling secondary to raised intracranial pressure (ICP) of unknown cause. Obesity is the most established and prevalent risk factor in developed countries. As obesogenic diets are high in calories and nutrient-poor, there may be associated nutritional deficiencies that contribute to the clinical presentation of IIH. Yet none, aside from iron deficiency, are currently included in the inclusion or exclusion criteria for the diagnosis of IIH. Our primary aim was to determine which micronutrient deficiencies, aside from iron deficiency, could present with optic disc swelling associated with or without intracranial hypertension that could potentially meet current IIH diagnostic criteria. To this end, we conducted a systematic search of articles published between 1 January 1980 and 18 December 2020 reporting cases of optic disc swelling associated with micronutrient deficiencies. In total, 65 cases met the eligibility criteria from initial searches: all were case reports and case series with a high risk of bias. Our findings suggest that patients with IIH or unexplained optic disc swelling ought to be screened, investigated, and treated for associated micronutrient deficiencies in vitamin A, B1 and B12; and weight loss interventions in IIH patients ought to promote better nutrition in addition to overall calorie restriction.

Wernicke Syndrome: Case Report and Literature Review of Contributing Factors—Can Malpractice Dynamics Be Identified?

“…Thiamine deficiency was caused by reduced intake (62.5%; 25/40) due to anorexia or vomiting, and many of these women (60%; 15/25) had hyperemesis gravidarum [18]. The physiopathology of optic neuropathy in thiamine deficiency seems to involve mitochondrial dysfunction [19]. Although WKS has mostly been reported and studied in patients with alcohol use disorders, such a trend appears to be shifting, with a growing body of scientific data accounting for nonalcoholic WKS among medical and surgical patient populations.…”

Vision Threatening Raised Intracranial Pressure Associated with Recreational Nitrous Oxide Use

“…Anaemia is a recognised risk factor for secondary pseudotumor cerebri, with up to 10% of cases with ICP having iron deficiency anaemia. 14 Reynolds et al 15 carried out a systematic review to identify other nutrient deficiencies which may be linked to optic disc swelling – vitamin B 12 deficiency was found to be linked to optic disc swelling in 11 cases, with two of the 11 cases also meeting the diagnostic criteria for IIH. In all cases, vitamin B 12 deficiency was a result of poor intake, rather than functional deficiency from a toxic cause.…”