Abstract
Objective: To consider the possibility of hypervitaminosis E in association with acute intracerebral hemorrhage (ICH), based on elevated serum levels of α-tocopherol.
Background: NA
Design/Methods: We describe the clinical presentation and course of three previously healthy individuals who each developed acute ICH and were discovered independently to be consuming copious amounts of vitamin E supplementation.
Results: Patient A and B both had thalamic (subcortical) intraparenchymal hemorrhages while patient C had an intraventricular hemorrhage; the serum α-tocopherol levels in all three were elevated at 30.8, 46.7 and 23.3 mg/L, respectively (normal range 5.7 – 19.9 mg/L). No definitive alternate etiologies to their ICH was found despite a thorough workup.
Conclusions: In patients with ICH without a clear-cut etiology, clinicians should avoid mislabeling the ICH as cryptogenic and consider the diagnosis of hypervitaminosis E. This can be accomplished by meticulously reviewing the patient’s pharmacologic history and asking about the use of over-the-counter supplements, such as vitamin E. Checking serum α-tocopherol levels in the acute/subacute phase may help confirm the history. The antiplatelet effect of vitamin E may considerably increase the risk of ICH, which may be underestimated, underreported, and heretofore unexplored in any clinically applicable way.
Disclosure: Dr. Le has nothing to disclose. Dr. Chang has nothing to disclose. Dr. Kesayan has nothing to disclose. Dr. Rose has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Boehringer Ingelheim, Boston Scientific, Medtronic, Chiesi and CSL-Behring. Dr. Rose has received research support from VuEssence; Boehringer Ingelheim; Biogen; ReNeuron; SanBio; Sunovion; Bristol-Myers Squibb; DART Neuroscience.
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Hastening the Diagnosis of Amyotrophic Lateral Sclerosis
Dr. Brian Callaghan and Dr. Kellen Quigg