Pseudotumor Cerebri Secondary to Minocycline Intake

Earl Robert G. Ang, MD, J. C. Chava Zimmerman, MD, Elissa Malkin, DO, MPH

Disclosures

J Am Board Fam Med. 2002;15(3) 

In This Article

Abstract and Introduction

Background: Pseudotumor cerebri, or idiopathic intracranial hypertension, is a condition most commonly affecting women of childbearing age who are obese or who have experienced recent weight gain. Frequently the patient complains of headache accompanied by dizziness, nausea, or visual defects, and it is characterized by elevated intracranial pressure in the absence of a space-occupying lesion or infection.
Methods: A patient had been prescribed minocycline and subsequently developed symptoms 6 weeks after an increase in the original dosage. She was initially examined by an ophthalmologist, then was sent to the Emergency Department, and finally admitted under the family practice service. Articles were searched through MEDLINE, MD Consult, and Google. Key words included "pseudotumor cerebri," benign intracranial hypertension," idiopathic intracranial hypertension," and "minocycline."
Results and Conclusion: Although the pathogenesis of pseudotumor cerebri is not completely understood, an association has been observed with minocycline use. This report describes a 16-year-old girl who developed idiopathic intracranial hypertension while taking minocycline for acne. Symptoms of blurred vision and severe headache unrelated to position or activity; an absence of fever, bilateral disk edema, and focalizing neurologic signs; negative neuroradiographic findings; increased cerebrospinal fluid pressure with a normal cell count; and exclusion of systemic or structural cause of increased intracranial pressure satisfy the criteria for the diagnosis of idiopathic intracranial hypertension. Minocycline is often used by family physicians for the treatment of acne, and this complication requires vigilance to protect against potential vision loss.

Idiopathic intracranial hypertension is a distinct syndrome in which patients have intracranial hypertension, papilledema, an absence of focal neurologic signs, and essentially normal cerebrospinal fluid. Benign intracranial hypertension, as it is also known, is usually a self-limited condition, although in some instances it can be a chronic condition. Annual incidence varies from 1 to 2 cases per 100,000 persons; however, among obese women in the reproductive age-group, the incidence jumps to 19 to 21 cases per 100,000.[1] The pathogenesis and natural course remains unclear.

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