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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Cryptogenic Intracranial Hemorrhagic Strokes Associated with Hypervitaminosis E and Acutely Elevated alpha-Tocopherol Levels
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Cryptogenic Intracranial Hemorrhagic Strokes Associated with Hypervitaminosis E and Acutely Elevated alpha-Tocopherol Levels

机译：与高血清胺蛋白含量和急性升高的α-生育酚水平相关的密码骨膜颅内出血淋巴

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Objectives: Up to 41% of intracerebral hemorrhages (ICH) are considered cryptogenic despite a thorough investigation to determine etiology. Certain overthe-counter supplements may increase proclivity to bleeding, and we hypothesize that specifically vitamin E may have an association with ICH and acutely elevated serum levels of a-tocopherol. Our aim is to report 3 cases of recently admitted patients with hypervitaminosis E and otherwise cryptogenic ICH. Methods: At our institution between January and December 2018, 179 patients were admitted with ICH with 73 imputed to be "cryptogenic" (without clear etiology as per Structural vascular lesions, Medication, Amyloid angiopathy, Systemic disease, Hypertension, or Undetermined and Hypertension, Amyloid angiopathy, Tumor, Oral anticoagulants, vascular Malformation, Infrequent causes, and Cryptogenic criteria). Of these, we found 3 (4.1%) clearly admitted to consistent use of vitamin E supplementation for which a-tocopherol levels were checked. We describe the clinical presentation and course of these patients and their etiologic and diagnostic evaluations including neuroimaging and a-tocopherol laboratory data. Results: All patients in this series were consistently consuming higher than recommended doses of vitamin E and developed acute ICH. The first 2 patients both had subcortical (thalamic) intraparenchymal hemorrhages while the third had an intraventricular hemorrhage. Serum a-tocopherol levels in patient A, B, and C were elevated at 30.8, 46.7, and 23.3 mg/L, respectively (normal range 5.7-19.9 mg/L) with a mean of 33.6 mg/L. No clear alternate etiologies to their ICH could be conclusively determined despite thorough workups. Conclusions: In patients with cryptogenic ICH, clinicians should consider hypervitaminosis E and check serum a-tocopherol level during admission. Reviewing the patient's pharmacologic history, including overthe-counter supplements such as vitamin E, may help identify its association, and its avoidance in the future may mitigate risk. With its known vitamin K antagonism, hypo-prothrombinemic effect, cytochrome p-450 interaction, and antiplatelet activity, vitamin E may not be as benign as presumed. Its consumption in nonrecommended doses may increase ICH risk, which may be underestimated and under-reported.
机译：目的：尽管对病因进行了彻底调查，但高达41%的脑出血（ICH）被认为是隐源性的。某些非处方补充剂可能会增加出血倾向，我们假设维生素E可能与脑出血和血清α-生育酚水平急性升高有关。我们的目的是报告3例最近入院的高浓度维生素E和其他隐源性脑出血患者。方法：2018年1月至12月在我院，179例ICH患者入院，其中73例被归为“隐源性”（根据结构性血管病变、药物治疗、淀粉样血管病、全身性疾病、高血压或未确定和高血压、淀粉样血管病、肿瘤、口服抗凝剂、血管畸形、罕见原因和隐源性标准，病因不明确）。在这些患者中，我们发现有3人（4.1%）明确承认持续服用维生素E补充剂，并对其进行了α-生育酚水平检查。我们描述了这些患者的临床表现和病程，以及他们的病因和诊断评估，包括神经影像学和α-生育酚实验室数据。结果：该系列中的所有患者持续摄入高于推荐剂量的维生素E，并发生急性脑出血。前两名患者均出现皮质下（丘脑）脑实质内出血，第三名患者出现脑室内出血。患者a、B和C的血清a-生育酚水平分别升高30.8、46.7和23.3 mg/L（正常范围为5.7-19.9 mg/L），平均值为33.6 mg/L。尽管进行了彻底的检查，仍无法确定ICH的明确替代病因。结论：在隐源性脑出血患者中，临床医生应考虑维生素E过多，并在入院时检查血清α-生育酚水平。回顾患者的药理学史，包括服用非处方补充剂（如维生素E）可能有助于确定其相关性，未来避免服用可能会降低风险。由于其已知的维生素K拮抗作用、低凝血酶原效应、细胞色素p-450相互作用和抗血小板活性，维生素E可能不像推测的那么良性。非推荐剂量的食用可能会增加ICH风险，这可能被低估和低估。

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