Vitamin Hydrocephalus

Table 10.4 lists the various medications that can be stopped and medical illnesses that can be treated to reverse dementia. In some cases, such as hypothyroidism or dehydration, the reversal can be complete. More often, the dementia is only partially reversed or its further progression is halted. Examples of these partial improvements include normal pressure hydrocephalus and vitamin B12 deficiency. 

Often both taste and smell are impaired in vitamin-A-deficient individuals, undoubtedly a result of a keratinizing effect. Hearing also may be impaired. Vitamin A deficiency can interfere with erythropoiesis, which may be masked by abnormal losses of fluid. Nerve lesions, increased cerebrospinal fluid pressure, and hydrocephalus have been reported. 

In addition, other possible causes of dementia also need to be excluded, especially the treatable forms of cognitive impairment, such as that due to depression, chronic drug intoxication, chronic central nervous system infection, thyroid disease, vitamin deficiencies (i.e.. Bn and thiamine), central nervous system angitis, and normal-pressure hydrocephalus (Bird, 2008). Individuals who do not meet these criteria but have short-term memory loss and have only minimal impairment in other cognitive abilities and are not functionally impaired at work or at home are considered to have mild cognitive impairment (Petersen et al., 2001). 

Gottrand F, Leclerc F, Chenaud M, VaUee L, Gaudier B. Une cause rare d hydrocephalie du nourrisson I intoxica-tion chronique par la vitamine A. [A rare cause of hydrocephalus in an infant chronic vitamin A poisoning.] Arch Fr Pediatr 1986 43(7) 501-2. 

Dementia due to other general medical condition (e.g, normal-pressure hydrocephalus, hypothyroidism, brain tumor, vitamin B12 deficiency, intracranial radiation)... 

Supplemental vitamin A is used in some neonatal treatment centers to reduce the risk of BPD and sepsis in preterm infants. However, concern over the risk of vitamin A toxicity (i.e., posthemorrhagic hydrocephalus or liver disease) and sequelae from repeated intramuscular injections of vitamin A prevent its widespread use. 

Hydrocephalus is a frequent complication of vitamin A deficiency. It would be tempting to attribute these changes to epithelial alteration of the choroid plexus (the structure that secretes cerebrospinal fluid), but there are no histological changes of the choroid plexus. Conversely, hydrocephalus due to vitamin A deficiency only occurs in children, and is therefore always associated with a retardation in bone growth. Hence, it is often assumed that the hydrocephalus results from anatomical interference with the development of the central nervous system, due to retarded bone growth. In any case, hydrocephalus due to vitamin A deficiency responds rapidly to the administration of the vitamin. 

Studies Blood connt, chemistry, and vitamin levels were normal. Syphilis test was negative. Brain MRI revealed a communicating hydrocephalus, with dilated frontal and temporal horns of the lateral ventricles, and slight-moderate periventricnlar white matter enhancement on contrast. No obstruction or focal mass was evident. 

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