Q: 21 year old female is admitted with severe headache. There is no past medical history except she is recently started on Minocycline for the treatment of her acne. What is your suspicion?



Answer: Pseudotumor cerebri (PTC) or idiopathic intracranial hypertension

Tetracycline, Doxycycline and Minocycline are known to cause PTC.The mechanism by which they induce pseudotumor cerebri is not known.

Minocycline may cause persistently elevated intracranial pressure, and may require medical and surgical treatment beyond discontinuation of the medication. It is not a benign condition and and aggressive interventions are needed to prevent severe morbidity like vision loss.



References:

• A. M. Chiu, W. L. Chuenkongkaew, W. T. Cornblath, et al., “Minocycline treatment and pseudotumor cerebri syndrome,” American Journal of Ophthalmology, vol. 126, no. 1, pp. 116–121, 1998.
• K. Mochizuki, T. Takahashi, M. Kano, K. Terajima, and N. Hori, “Pseudotumor cerebri induced by minocycline therapy for acne vulgaris,” Japanese Journal of Ophthalmology, vol. 46, no. 6, pp. 668–672, 2002.
• D. I. Friedman, L. K. Gordon, R. A. Egan, et al., “Doxycycline and intracranial hypertension,” Neurology, vol. 62, no. 12, pp. 2297–2299, 2004.
• A. Kesler, Y. Goldhammer, A. Hadayer, and P. Pianka, “The outcome of pseudotumor cerebri induced by tetracycline therapy,” Acta Neurologica Scandinavica, vol. 110, no. 6, pp. 408–411, 2004.