Benign intracranial hypertension after antibiotic therapy

Idiopathic intracranial hypertension associated with tetracycline use in fraternal twins: case reports and review

Fraternal twin sisters developed idiopathic intracranial hypertension (IIH) shortly after beginning tetracycline for treatment of acne. We reviewed from the literature 19 familial cases of IIH and 37 cases of IIH associated with tetracycline usage. Among the 37 combined adult and pediatric cases, 26 of 37 had resolution of signs or symptoms of IIH within hours to days of stopping the antibiotic, and rapid recurrence with reinitiation of drug occurred in 4 of 37. We suggest that these cases may be tetracycline-induced, may be related to an underlying genetic susceptibility, and support the notion of multifactorial etiologies for IIH.

Congenital protein C deficiency and superior sagittal sinus thrombosis causing isolated intracranial hypertension

The first case of a superior sagittal sinus thrombosis causing isolated intracranial hypertension as a result of congenital protein C deficiency is reported. Such a possibility must not be overlooked. Anticoagulation is recommended as a treatment for cerebral venous thrombosis. In the case of congenital protein C deficiency, vitamin K antagonists must be started cautiously due to the risk of skin necrosis.

Pediatric pseudotumor cerebri (idiopathic intracranial hypertension)

This review focuses on the features of pseudotumor cerebri in the pediatric age group. There is no sex predilection in children, and obesity does not appear to be an important factor. Infants and young children may present with irritability, apathy, or somnolence, rather than headache. Dizziness and ataxia may also occur. Papilledema is infrequently noted in pediatric patients if the fontanelles are open or the sutures are split. Pre-adolescents appear more likely than adults or adolescents to have manifestations of their pseudotumor cerebri other than headache and papilledema, including lateral rectus pareses, vertical strabismus, facial paresis, back and neck pain. Among the etiologies that are particularly pertinent to children are tetracycline therapy, malnutrition or renutrition, and the correction of hypothyroidism. Children with pseudotumor cerebri are at risk for visual loss and their visual function must be closely monitored. Surgical intervention is imperative when vision is threatened.

The tetracyclines

Tetracyclines continue to be used extensively on a world-wide basis because of their unusually broad antimicrobial spectrum and their relative safety. The first generation tetracyclines are used almost exclusively via the oral route; the second generation tetracyclines may be used orally or intravenously. Intramuscular administration is not recommended. Doxycycline is preferred in the treatment of upper respiratory tract infections, atypical pneumonias, intraabdominal/pelvic sepsis or trauma, venereal diseases, and in the treatment of prostatitis. Minocycline is preferred for meningococcal prophylaxis, central nervous system infections (due to susceptible organisms), and in staphylococcal infections (when tetracycline is indicated).