Minocycline-Induced Fulminant Intracranial Hypertension

Abstract

To describe the clinical course of an unusually severe case of minocycline-induced intracranial hypertension.

Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children

“…In addition to addressing the secondary cause, these patients frequently require treatments used for IIH in order to prevent blindness. 23,24 With these points in mind, we propose updated criteria for the diagnosis of PTCS in adults and children. Our objective is to provide accurate parameters for reliably diagnosing patients, in order to identify them promptly at presentation, obtain the necessary diagnostic testing, and institute treatment to avoid/minimize visual loss.…”

Critical data‐based re‐evaluation of minocycline as a putative specific microglia inhibitor

“…These vestibular side effects are more common in women than in men, occurring with a frequency of up to 7/10 (Fanning et al, 1977). Minocycline has other well-described peripheral and central side effects and because of multiple potential safety issues, the FDA added minocycline to its Adverse Event Reporting System (ARES) in 2009 effects (Balestrero et al, 2001;Cohen, 2004;Davies and Kersey, 1989;Fraser et al, 2012;Golstein et al, 1997;Gordon et al, 1995;Gough et al, 1996;Hanada et al, 2016;Hardman et al, 1996;Healy et al, 2009;Lander, 1989;Lefebvre et al, 2007;Matsuura et al, 1992;Porter and Harrison, 2003;Schlienger et al, 2000;van Steensel, 2004;Weller and Klockgether, 1998). That said, minocycline remains a mainstay drug for antibacterial therapy and has been taken safely and efficiently by millions of people.…”

Reversibility of MRI Features of Pseudotumor Cerebri Syndrome

“…Minocycline-associated PTCS typically occurs within two months of starting (or increasing) the drug 1 , as it did with our patient, although delays as long as one year have been reported 1 . Minocycline-associated PTCS can be severe or even fulminant 3 . The associated papilledema and visual field defects range from mild to severe, and opening CSF pressures on lumbar puncture can be extremely high.…”

“…Cessation of minocycline typically results in rapid resolution of the syndrome of raised ICP and no recurrence of the disease; however, when the optic nerves have been permanently injured from acute papilledema, visual field defects may persist 1 . In severe or fulminant cases, optic atrophy and severe permanent vision loss may occur 3 .…”