Intracranial hypertension: the hidden risk of supplements containing vitamin A

Hypervitaminosis A is relatively uncommon but may develop with excessive supplementation or medication use. We report a 17-year-old non-obese male presenting with symptomatic papilloedema and normal neuroimaging. Investigations excluded alternative causes, but a detailed history identified that he used a protein supplement containing significant amounts of vitamin A. Although there are potential confounding factors, the combination of the clinical presentation, deranged liver function tests, resolution following the diagnostic lumbar puncture, starting acetazolamide and stopping the supplements supported a diagnosis of vitamin A-induced intracranial hypertension. With the rising global use of dietary supplements, clinicians should routinely enquire about over-the-counter products in people with unexplained intracranial hypertension to reduce avoidable investigations, prolonged treatments and risk of visual morbidity.