LETTER
Intracranial Hypertension and Minocycline
Joseph Shiri, MD, and
Boaz Amichai, MD
15 July 1997 | Volume 127 Issue 2 | Page 168
TO THE EDITOR:
We report a case of intracranial hypertension with permanent visual damage after minocycline treatment.
A 19-year-old healthy woman was treated with minocycline, 100 mg/d, for acne vulgaris. Two weeks after treatment began, the patient presented with severe headache, nausea, and visual disturbance. Ophthalmologic examination revealed severe bilateral papilledema with visual field damage. A computed tomographic scan of the brain was normal. After minocycline therapy was discontinued and acetazolamide was administered, the papilledema disappeared. However, the patient's visual fields and visual acuity are permanently damaged.
Tetracyclines, especially minocycline, are widely used to treat acne vulgaris. Despite the listed side effects of the tetracycline groups, therapy with these agents is safe. Intracranial hypertension or pseudotumor cerebri is well known in infants but rare in adults [1]. Intracranial pressure is also common in patients treated by both tetracyclines and retinoids [2]. Among the few cases reported in the literature, elevated intracranial pressure was more common in women; neurologic and ophthalmologic symptoms developed 1 month after therapy began; and, in most cases, neurologic and ophthalmologic symptoms and signs were alleviated after discontinuation of minocycline therapy [1, 3]. In some patients, however, visual acuity was permanently damaged [4]. One patient required lumboperitoneal bypass [5].
Minocycline is known to penetrate into the central nervous system and to have good lipoid solubility. The mechanism by which minocycline increases intracranial pressure is unknown. Awareness of this cause of headache and visual obseuration may prevent severe, permanent neurologic damage.
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Author and Article Information
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Tel-Nordoy Clinic; Tel-Aviv, Israel
1. Lubetzki C, Sanson M, Cohen D, et al. Benign intracranial hypertension and minocycline. Rev Neurol Paris. 1988; 144:218-20.
2. Delaney RA, Narayanswamy TR, Wee D. Pscudo-tumor cerebri and acne. Mil Med. 1990:155:511.
3. Le-Bris P, Glacet-Breard A, Coscas G, et al. Papilledema caused by minocycline: apropos of a case. J Fr Ophthalmol. 1988:11:681-4.
4. Lander CM. Minocycline-induced benign intracranial hypertension. Clin Exp Neurol. 1989; 26:161-7.
5. Donnet A, Dufour H, Graziani N, et al. Minocycline and benign intracranial hypertension. Biomed Pharmacother. 1992; 46:171-2.
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