MINOCYCLINE TREATMENT AND PSEUDOTUMOR CEREBRI SYNDROME

PURPOSE: To demonstrate the association between minocycline treatment and development of I-he pseudotumor cerebri syndrome. METHODS: A retro spective study was conducted of 12 patients from five neuro-ophthalmic referral centers who developed pseudotumor cerebri syndrome after bei ng treated with standard doses of minocycline for refractory acne vulg aris. The main outcome measures included resolution of headaches, tran sient visual obscurations, diplopia, papilledema, and visual fields st atic thresholds after withdrawal of minocycline and treatment for incr eased intracranial pressure. RESULTS: Nine (75%) of the 12 patients de veloped symptoms of the pseudotumor cerebri syndrome syndrome within 8 weeks of starting minocycline therapy; six were not obese. Two patien ts developed symptoms only after a year had elapsed because of commenc ement of treatment with minocycline, One patient was asymptomatic, and pseudotumor cerebri syndrome was diagnosed by finding papilledema on routine examination 1 year after minocycline was started. None of the patients developed recurrences for at least 1 year after the discontin uation of minocycline and treatment for increased intracranial pressur e, but three (25%) of the 12 patients had substantial residual visual field loss. CONCLUSION: Minocycline is a cause or precipitating factor in pseudotumor cerebri syndrome. Although most patients have prominen t symptoms and are diagnosed promptly, others are asymptomatic and may have optic disk edema for a long period of time before diagnosis. Wit hdrawal of minocycline and treatment for increased intracranial pressu re lead to resolution of the pseudotumor cerebri syndrome, but visual field loss may persist. (C) 1998 by Elsevier Science Inc. All rights r eserved.