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Assardoun M, Naji Y, Nedday S, Laadami S, Adali N. Antibiotics-Induced Intracranial Hypertension: A Case Report With Literature Review. Cureus 2024; 16:e55424. [PMID: 38567240 PMCID: PMC10985648 DOI: 10.7759/cureus.55424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2024] [Indexed: 04/04/2024] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a rare condition characterized by increased intracranial pressure, with an unknown cause. However, the pathophysiology of antibiotic-induced IIH remains unclear. The clinical symptoms include headache, visual disturbances, and vomiting. The diagnosis is confirmed by an elevated intracranial pressure (ICP) with normal CSF study and cerebral imaging. Management includes discontinuing the offending antibiotic and reducing ICP with medications such as acetazolamide or diuretics. Therefore, surgical intervention may be necessary in severe cases. In this article, we report the case of a 19-year-old patient, admitted with symptoms of intracranial hypertension syndrome, occurring three days after receiving antibiotics (gentamicin, penicillin). Physical examination revealed bilateral optic disc edema. Cerebral magnetic resonance imaging (MRI) revealed indirect signs of intracranial hypertension. The CSF pressure measurement was approximately 290 mmHg, while CSF and other laboratory blood tests were normal. The patient received methylprednisolone bolus and topiramate (50 mg/day). A month later, the clinical outcome showed regression of headaches and regression of the papilledema.
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Affiliation(s)
- Mariam Assardoun
- Department of Neurology, Agadir University Hospital, Agadir, MAR
- Department of Neurology, Neurosciences Innovation Cognition Ethique (NICE) Research Team, Rein Endocrinologie Gastroentérologie Neurosciences Ethique (REGNE) Research Laboratory, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, MAR
| | - Yahya Naji
- Department of Neurology, Agadir University Hospital, Agadir, MAR
- Department of Neurology, Neurosciences Innovation Cognition Ethique (NICE) Research Team, Rein Endocrinologie Gastroentérologie Neurosciences Ethique (REGNE) Research Laboratory, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, MAR
| | - Soumia Nedday
- Department of Neurology, Agadir University Hospital, Agadir, MAR
- Department of Neurology, Neurosciences Innovation Cognition Ethique (NICE) Research Team, Rein Endocrinologie Gastroentérologie Neurosciences Ethique (REGNE) Research Laboratory, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, MAR
| | - Sara Laadami
- Department of Neurology, Agadir University Hospital, Agadir, MAR
- Department of Neurology, Neurosciences Innovation Cognition Ethique (NICE) Research Team, Rein Endocrinologie Gastroentérologie Neurosciences Ethique (REGNE) Research Laboratory, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, MAR
| | - Nawal Adali
- Department of Neurology, Agadir University Hospital, Agadir, MAR
- Department of Neurology, Neurosciences Innovation Cognition Ethique (NICE) Research Team, Rein Endocrinologie Gastroentérologie Neurosciences Ethique (REGNE) Research Laboratory, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, MAR
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2
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Goldberg DJ, Andriessen A, Bhatia AC, Gold MH, Lewis AB, Lolis MS, Miller JH, Ros A. Treatment of mild to severe acne with 1726 nm laser: A safe alternative to traditional acne therapies. J Cosmet Dermatol 2023; 22:3026-3032. [PMID: 37596781 DOI: 10.1111/jocd.15964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Acne is the most common reason for dermatology consultation in adolescents and young adults. Consultation is often delayed despite unsuccessful self-treatment. Postponing effective treatment places acne sufferers at higher risk for permanent acne scars and post-inflammatory pigment changes. AIM This review discusses clinical challenges with present therapeutic options for acne treatment and the role of a 1726 nm laser for acne. METHODS Current acne treatment guidelines were reviewed. A literature review was conducted for trials of light-based acne therapy. The selectivity of previous light-based therapies was reviewed. RESULTS Available acne therapy is effective, but treatment-related side effects are common. Acne treatment guidelines do not include recommendations for light-based treatments. Different types of light-based treatments have been tried but until now no wavelength specifically targeted sebaceous glands. CONCLUSION The 1726 nm laser is safe and effective for treating mild to severe acne in all Fitzpatrick skin types. Acne resolution is apparent within the first month and improves for up to 2 years beyond treatment.
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Affiliation(s)
- David J Goldberg
- Cosmetic Dermatology and Clinical Research, Schweiger Dermatology Group, Clinical Professor of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Anneke Andriessen
- Radboud UMC Nijmegen, Andriessen Consultants, Malden, The Netherlands
| | - Ashish C Bhatia
- Department of Dermatology, Northwestern University - Feinberg School of Medicine, Chicago, Illinois, USA
- Dermatologic, Laser & Cosmetic Surgery, Oak Dermatology, Naperville, Illinois, USA
- Dermatologic Research, Oak Dermatology, Naperville, Illinois, USA
| | - Michael H Gold
- Founder of Gold Skin Care Center, Nashville, Tennessee, USA
- Vanderbilt University School of Medicine and Nursing, Nashville, Tennessee, USA
| | - Amy B Lewis
- Schweiger Dermatology Group, New York, New York, USA
| | | | | | - Adriana Ros
- Medical and cosmetic dermatology, North Bergen, New Jersey, USA
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Neuroimaging in the diagnosis and treatment of intracranial pressure disorders. Neurol Sci 2023; 44:845-858. [PMID: 36333629 DOI: 10.1007/s10072-022-06478-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To review the clinical features, proposed pathophysiology, and the role of medical imaging in the diagnosis and treatment of idiopathic intracranial hypertension and spontaneous intracranial hypotension. METHODS The authors conducted a narrative review of the current literature on intracranial hypertension and hypotension syndromes, with a focus on imaging findings and role of neurointerventional radiology as a therapeutic option for these pathologies. RESULTS Idiopathic intracranial hypertension commonly presents in obese women of childbearing age, being headache and papilledema the main clinical manifestations. Characteristic radiological findings consist of increased cerebrospinal fluid around the optic nerve, partially empty sella turcica and stenosis of the transverse sinuses. Transverse sinus stenting is a treatment alternative that has proven valuable utility in the recent years. Spontaneous intracranial hypotension in most of cases presents with orthostatic headache and has predilection for female population. The typical radiological features in the brain consist of subdural fluid collections, enhancement of the dura, engorgement of the venous structures, pituitary enlargement, and sagging of the brain. In this pathology, a cerebrospinal fluid leak in the spine associated with a defect in the dura, meningeal diverticulum, or a cerebrospinal fluid-venous leak must be actively ruled out. CONCLUSIONS Neurologic complaints secondary to changes in intracranial pressure exhibit certain clinical features that in combination with fairly specific radiological patterns allow a highly accurate diagnosis. The diverse specialists in neurosciences should be aware of the multiple image modalities in the study of these syndromes as well as the treatment alternatives by neurointerventional radiology.
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Cohen R, Mahajnah M, Shlonsky Y, Golan-Shany O, Romem A, Halevy A, Natan K, Genizi J. Prospective, Cross-Sectional Study Finds No Common Viruses in Cerebrospinal Fluid of Children with Pseudotumor Cerebri. Brain Sci 2023; 13:brainsci13020361. [PMID: 36831904 PMCID: PMC9953968 DOI: 10.3390/brainsci13020361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Pseudotumor cerebri (PTC) in children is a rare condition whose underlying cause remains largely unknown. No study has yet systematically examined viral infection as a cause of PTC. The current study aimed to characterize PTC in children and investigate the possible role of acute viral infection of the central nervous system in its pathogenesis. A prospective, cross-sectional study was conducted in three centers in Israel. Participants were 50 children aged 0.5-18 years, of whom 27 had a definitive diagnosis of pseudotumor cerebri (the study group) and 23 comprised a control. Data collected included clinical presentation, imaging, treatment, ophthalmic findings, and cerebrospinal fluid (CSF) analysis. Using the ALLPLEXTM meningitis panel, real-time polymerase chain reaction (PCR) was used to test for the presence of 12 common viruses. PTC patients (mean age 12 ± 4.3 years; 14 males, 13 females) had mean opening pressure of 41.9 ±10.2 mmH2O. All PTC patients had papilledema, and 25 (93%) had PTC symptoms. No viruses were found in the PTC group, while in the control group, one patient tested positive for Epstein-Barr virus and another for human herpesvirus type 6. Overall, in our study, PTC was not found to be associated with the presence of viruses in CSF.
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Affiliation(s)
- Rony Cohen
- Department of Pediatric Neurology, Schneider Children’s Medical Center of Israel, Petah Tikva 4920235, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Muhammad Mahajnah
- Pediatric Neurology Unit, Hillel Yaffe Medical Center, Hadera 38100, Israel
- Bruce Rappaport Faulty of Medicine, Technion (Israel Institute of Technology), Haifa 3104802, Israel
| | - Yulia Shlonsky
- Microbiology Labratory, Bnai Zion Medical Center, Haifa 3104802, Israel
| | - Orit Golan-Shany
- Microbiology Labratory, Bnai Zion Medical Center, Haifa 3104802, Israel
| | - Azriel Romem
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel
| | - Ayelet Halevy
- Department of Pediatric Neurology, Schneider Children’s Medical Center of Israel, Petah Tikva 4920235, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Keren Natan
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel
| | - Jacob Genizi
- Bruce Rappaport Faulty of Medicine, Technion (Israel Institute of Technology), Haifa 3104802, Israel
- Pediatric Department, Bnai Zion Medical Center, Haifa 3104802, Israel
- Correspondence:
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Shon U, Yun DK, Choi MS, Park BC, Kim MH. Secondary Intracranial Hypertension Associated with Alitretinoin Treatment for Twenty-Nail Dystrophy. Ann Dermatol 2022; 34:485-486. [PMID: 36478433 PMCID: PMC9763903 DOI: 10.5021/ad.20.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Uri Shon
- Department of Dermatology, College of Medicine, Dankook University, Cheonan, Korea
| | - Dea Kwan Yun
- Department of Dermatology, College of Medicine, Dankook University, Cheonan, Korea
| | | | - Byung Cheol Park
- Department of Dermatology, College of Medicine, Dankook University, Cheonan, Korea
| | - Myung Hwa Kim
- Department of Dermatology, College of Medicine, Dankook University, Cheonan, Korea
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6
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Bhardwaj P, Lim SY, Gruener AM. Pseudotumor cerebri syndrome secondary to lymecycline therapy. Eur J Ophthalmol 2022; 32:NP102-NP104. [PMID: 35037776 DOI: 10.1177/11206721211072373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- P Bhardwaj
- Department of Ophthalmology, 9820Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - S Y Lim
- Department of Neurology, 9820Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A M Gruener
- Department of Ophthalmology, 9820Nottingham University Hospitals NHS Trust, Nottingham, UK.,School of Medicine, 6123University of Nottingham, Nottingham, UK
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7
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Fallah H, Rademaker M. Isotretinoin for acne vulgaris - an update on adverse effects and laboratory monitoring. J DERMATOL TREAT 2021; 33:2414-2424. [PMID: 34379039 DOI: 10.1080/09546634.2021.1967269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
A significant barrier to the usage of isotretinoin has been concerns regarding its adverse effect profile. The dose-dependent mucocutaneous side effects of isotretinoin are well recognised and easily managed, particularly if a lower dose is used. A possible association with depression has gained widespread media attention and is a source of concern for many patients and their carers, but data from prospective studies and recent meta-analyses has been reassuring. Furthermore, there has been much confusion amongst both patients and physicians regarding a possible association with inflammatory bowel disease, as well the ocular and rheumatological adverse effects of isotretinoin. We provide an update on the evidence surrounding the adverse effects of isotretinoin, and discuss practical strategies to prevent and manage these adverse effects. We also discuss appropriate laboratory monitoring for patients taking isotretinoin.
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Affiliation(s)
- Haady Fallah
- The University of Sydney, Sydney, Australia.,Concord Repatriation General Hospital, Sydney, Australia.,The Skin Hospital, Sydney, Australia
| | - Marius Rademaker
- Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
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8
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Alkoht A, Alhariry H, Hanafi I, Aboud M. Idiopathic intracranial hypertension with juvenile idiopathic arthritis-associated uveitis: A case report. Clin Case Rep 2021; 9:e04281. [PMID: 34194789 PMCID: PMC8222758 DOI: 10.1002/ccr3.4281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 11/23/2022] Open
Abstract
A 14-year-old girl with juvenile idiopathic arthritis (JIA)-associated uveitis who also had optic disc edema, was later diagnosed with Idiopathic intracranial hypertension (IIH). To our knowledge, this is the fifth case of the coexistence of uveitis and IIH among children, and the only one with no obvious risk factors for IIH.
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Affiliation(s)
- Asaad Alkoht
- Faculty of MedicineDivision of RheumatologyDepartment of Internal MedicineDamascus UniversityDamascusSyria
| | - Huda Alhariry
- Faculty of MedicineDivision of RheumatologyDepartment of Internal MedicineDamascus UniversityDamascusSyria
| | - Ibrahem Hanafi
- Faculty of MedicineDivision of NeurologyDepartment of Internal MedicineDamascus UniversityDamascusSyria
| | - Majed Aboud
- Faculty of MedicineDivision of RheumatologyDepartment of Internal MedicineDamascus UniversityDamascusSyria
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9
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Graber EM. Treating acne with the tetracycline class of antibiotics: A review. ACTA ACUST UNITED AC 2021. [DOI: 10.1002/der2.49] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Emmy M. Graber
- Affiliate Clinical Instructor Northeastern University Boston Massachusetts USA
- The Dermatology Institute of Boston Boston Massachusetts USA
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10
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11
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Li Y, Desai K, Morrison B, Galimberti F. Availability of prescription medications for sale without a prescription on the internet in the United States. Int J Dermatol 2020; 60:e65-e66. [PMID: 33232516 DOI: 10.1111/ijd.15123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/30/2020] [Accepted: 07/15/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Yumeng Li
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, USA.,Jackson Memorial Hospital, Miami, FL, USA
| | - Karsihma Desai
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, USA
| | - Brian Morrison
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, USA.,Jackson Memorial Hospital, Miami, FL, USA
| | - Fabrizio Galimberti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miami, FL, USA.,Jackson Memorial Hospital, Miami, FL, USA
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12
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Houlihan LM, Marks C. Cerebrospinal fluid hydrodynamics in arachnoid cyst patients with persistent idiopathic intracranial hypertension: A case series and review. Surg Neurol Int 2020; 11:237. [PMID: 32874740 PMCID: PMC7451167 DOI: 10.25259/sni_129_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/20/2020] [Indexed: 01/04/2023] Open
Abstract
Background: A clear connection has been established between arachnoid cysts (ACs) and the evolution of idiopathic intracranial hypertension (IIH), a connection, which is presently not well understood. Cerebrospinal fluid (CSF) is an integral element of this condition. Little is known about either the influence of AC on CSF hydrodynamics or the specific nature of CSF, which contributes to the complex pathology of IIH. Case Description: This study aimed to chronicle in detail four patients with previously treated intracranial ACs, who developed persistent IIH. This series and review aims to identify and qualitatively analyze the multiple constituents, which could possibly elucidate the intrinsic relationship between arachnoid cyst-induced IIH and CSF hydrodynamics. A retrospective analysis of the medical records of four patients admitted to the institution’s neurosurgery department during the period of 1994–2013 was completed. This study investigated discernible aspects linking CSF pathophysiology with the development of IIH in AC patients. Four male patients, ranging from 3 to 44 years of age at presentation, had a left-sided arachnoid cyst treated surgically. All four patients subsequently developed IIH. Three patients remain persistently symptomatic. Conclusion: IIH associated with AC is a hydrodynamic disorder. The full discovery of its fluctuant pathophysiology is the only way to identify an effective standard for the management and treatment of this condition.
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Affiliation(s)
| | - Charlie Marks
- Department of Neurosurgery, Cork University Hospital, Cork, Ireland
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13
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Alboudi A, Johnson EC. Unusual presentation of idiopathic intracranial hypertension. BMJ Case Rep 2020; 13:13/5/e234741. [PMID: 32475825 DOI: 10.1136/bcr-2020-234741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Idiopathic intracranial hypertension typically presents with holocephalic headache associated with nausea, vomiting and bilateral papilledema. Involvement of the sixth cranial nerve is relatively common. The involvement of other cranial nerves, however, is rare in this disorder. We describe a patient with idiopathic intracranial hypertension who presented with episodic unilateral retro-orbital pain and multiple cranial nerve abnormalities without papilledema. Imaging studies excluded alternate diagnoses, and the immediate resolution of symptoms after lumbar puncture confirmed that these symptoms were due to intracranial hypertension. Atypical presentations of such a disabling yet treatable disorder is very important to recognise and address.
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Affiliation(s)
- Ayman Alboudi
- Neurology, Michigan State University, East Lansing, Michigan, USA .,Department of Neurology, Mercy Health Saint Mary's, Grand Rapids, Michigan, USA
| | - Emily C Johnson
- Mercy Health Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, Michigan, USA
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Togha M, Martami F, Rahmanzadeh R, Ghorbani Z, Refaeian F, Behbahani S, Panahi P, Moghadam NB, Nafissi S, Shahbazi M. The role of opening CSF pressure in response to treatment for idiopathic intracranial hypertension (IIH). J Clin Neurosci 2020; 76:171-176. [PMID: 32331944 DOI: 10.1016/j.jocn.2020.04.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/12/2020] [Indexed: 10/24/2022]
Abstract
The aim of the current study was to assess the risk factors, clinical symptoms and Cerebrospinal fluid (CSF) pressure of idiopathic intracranial hypertension (IIH) with emphasis on determining the risk factors which involved in poor response to treatment. We retrospectively included 202 patients who were diagnosed with IIH. Disease severity was classified according to prescribed therapeutic option into 4 groups: acetazolamide (group 1), Acetazolamide plus topiramate or Lasix (group 2), repeated LP (group 3) and surgical intervention (group 4). Being in the higher group was considered as a higher severity of disease and poor response to treatment. Among the evaluated features of IIH, the strongest association were observed between opening CSF pressure and disease severity. So that, the highest CSF pressure was observed in patients who underwent surgery, which represent the highest severity of disease (group 4) and poor response to therapy (mean ± SD: 43.9 ± 21.1 cm H2O). Headache was the most prevalent symptom of IIH in our series which was significantly higher among acetazolamide group. Blurred vision was the second most common symptoms which, unlike the headache was more reported in surgery group. Our results suggested that higher CSF pressure could be the risk factors of poor response to therapy, which may raise need for more intensive treatment. Furthermore, suffering of headache without blurred vision can consider as a prognostic factor for mild severity and good response to treatment.
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Affiliation(s)
- Mansoureh Togha
- Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran.
| | - Fahimeh Martami
- Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran
| | - Reza Rahmanzadeh
- Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran
| | - Zeinab Ghorbani
- Guilan University of Medical Sciences, Department of Cardiology, Heshmat Hospital, Cardiovascular Disease Research Center, Rasht, Iran
| | - Farshid Refaeian
- Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran
| | - Shirin Behbahani
- Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran
| | - Parsa Panahi
- Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran
| | - Nahid Beladi Moghadam
- Shahid Beheshti University of Medical Sciences, Department of Neurology, Imam Hossein Hospital, Tehran, Iran
| | - Shahriar Nafissi
- Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran
| | - Mojtaba Shahbazi
- Tehran University of Medical Sciences, Headache Department, Iranian Center of Neurological Research, Tehran, Iran
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15
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Tan MG, Worley B, Kim WB, ten Hove M, Beecker J. Drug-Induced Intracranial Hypertension: A Systematic Review and Critical Assessment of Drug-Induced Causes. Am J Clin Dermatol 2020; 21:163-172. [PMID: 31741184 DOI: 10.1007/s40257-019-00485-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a condition with increased intracranial pressure of unknown etiology. Its presenting symptoms include persistent headache, pulsatile tinnitus, and visual obscuration. It tends to occur in obese women of childbearing age, and its greatest risk is irreversible loss of vision. Some of the commonly used medications in dermatology, especially those for acne vulgaris, have been associated with IIH. However, the creation of specific risk categories for drugs as a guide for clinicians has never been performed. OBJECTIVE The aim of this study was to critically assess all published cases of IIH and identify high-risk drugs associated with drug-induced intracranial hypertension (DIIH), to assist dermatologists and other physicians with patient education and monitoring of symptoms of secondary intracranial hypertension. METHODS MEDLINE, EMBASE, and Cochrane Review Databases were searched for all cases of IIH thought to be drug-related between January 1900 and June 2019. A total of 5117 articles were identified, and 235 articles were found to be relevant. All cases were assessed to satisfy the modified Dandy criteria for diagnosis of IIH, and the likelihood of each case being a 'definite' adverse drug reaction (ADR) was determined using the Koh algorithm for ADR. An association category (from weakly associated [Category I] to strongly associated [Category V]) was assigned based on the number of cases meeting these two criteria. RESULTS There were 259 verifiable cases of DIIH. Vitamin A derivatives, tetracycline-class antibiotics, recombinant growth hormone, and lithium were found to be most strongly associated with DIIH (Categories IV and V). Corticosteroids were moderately associated with DIIH (Category III). Drugs that were weakly associated with DIIH (Categories I and II) include cyclosporine, progestin-only contraceptives, combined oral contraceptives, second- and third-generation fluoroquinolones, sulfenazone, gonadotropin-releasing hormones and luteinizing hormone-releasing hormone agonist, nalidixic acid, amiodarone, stanozolol, danazol, divalproic acid, sulfasalazine, ketoconazole, and ustekinumab. CONCLUSION We suggest using the term 'drug-induced intracranial hypertension' (DIIH) and propose a set of diagnostic criteria for DIIH. Our review attempts to identify DIIH-associated drugs based on a strict diagnostic and drug-causality algorithm, then stratify them into appropriate risks categories. This may ultimately assist physicians in counselling patients about the risk of DIIH when prescribing medications and recognizing this uncommon yet sight-threatening condition.
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Clemens V, Regen F, Le Bret N, Heuser I, Hellmann-Regen J. Anti-inflammatory effects of minocycline are mediated by retinoid signaling. BMC Neurosci 2018; 19:58. [PMID: 30241502 PMCID: PMC6151010 DOI: 10.1186/s12868-018-0460-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 09/17/2018] [Indexed: 01/23/2023] Open
Abstract
Background Minocycline is a lipophilic tetracycline of increasing appeal in neuroscience as it inhibits microglial activation, a mechanism involved in numerous neuropsychiatric disorders. Own data point towards retinoid-mediated effects of minocycline in murine brain and skin, and towards a vicious cycle of neuroinflammation which is driven by microglial activation-induced breakdown of local retinoids such as retinoic acid (RA). We therefore sought to study minocycline’s anti-inflammatory effects on human microglial-like monocyte-derived cells in the context of retinoid signaling. Results As hypothesized, minocycline exposure resulted in a substantial increase of RA levels in the human monocytic cell line THP-1. While pro-inflammatory stimulation with lipopolysaccharides resulted in increased tryptophane-degrading indoleamine-2,3-dioxygenase IDO-expression and TNF-α levels in primary human monocyte-derived microglial-like cells, this effect was attenuated by minocycline only in the presence of retinoids. The anti-inflammatory effects of minocycline on TNF-α expression were completely abolished by a pharmacological blockage of retinoic acid receptors (RARs) using BMS-493 and unaffected by selectively blocking retinoid-X-receptors using UVI-3003. Conclusions Our data indicate for the first time a RA-dependent, anti-inflammatory effect for minocycline in human microglial-like cells via inhibition of local RA turnover. The RA-dependent mode of action for minocycline appears to be predominantly mediated through RAR-signaling.
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Affiliation(s)
- Vera Clemens
- Section Clinical Neurobiology, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Francesca Regen
- Section Clinical Neurobiology, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Nathalie Le Bret
- Section Clinical Neurobiology, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Isabella Heuser
- Section Clinical Neurobiology, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Julian Hellmann-Regen
- Section Clinical Neurobiology, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
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Khattar R, Edwards R, Crum-Cianflone NF. Abnormal Ophthalmic Examination Results and Elevated Intracranial Pressure. JAMA Ophthalmol 2018; 136:1068-1069. [PMID: 29978178 DOI: 10.1001/jamaophthalmol.2018.0085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Ramni Khattar
- Internal Medicine Department, Scripps Mercy Hospital, San Diego, California
| | - Russell Edwards
- Ophthalmology Department, Scripps Mercy Hospital, San Diego, California
| | - Nancy F Crum-Cianflone
- Infectious Disease Division, Internal Medicine Department, Scripps Mercy Hospital, San Diego, California
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18
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Abstract
PURPOSE OF REVIEW This review presents a critical appraisal of current therapeutic strategies for patients with idiopathic intracranial hypertension (IIH). We present the reader with the most recent evidence to support medical and surgical interventions in patients with IIH and provide recommendations about treatment initiation and escalation. We also indicate areas where knowledge gaps exist regarding therapeutic efficacy and superiority of one intervention over another. RECENT FINDINGS A double-masked, randomized prospective study of medical management of patients with mild IIH (Idiopathic Intracranial Hypertension Treatment Trial-IIHTT) has established that acetazolamide therapy has additional efficacy when compared to weight loss alone. Furthermore, management of IIH-related headache, even in patients with papilledema, may require treatment other than ICP lowering for patients to experience symptomatic relief. Finally, a number of uncontrolled interventional studies have shown transverse sinus stenting to be a potentially effective treatment for medically refractory IIH. Medical therapy with acetazolamide should be considered in addition to structured weight loss in patients with mild IIH. Surgical treatment for patients with vision-threatening disease IIH can be performed by either optic nerve sheath fenestration or cerebrospinal fluid diversion, with venous sinus stenting emerging as an alternate therapy. Headache relief from ICP lowering therapy is variable and often not sustained.
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Affiliation(s)
- Sivashakthi Kanagalingam
- Department of Surgery, Division of Ophthalmology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Prem S Subramanian
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, 1675 Aurora Court, Mailstop F-731, Aurora, CO, 80045, USA.
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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19
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Sarkar T, Sarkar S, Patra A. Low-dose isotretinoin therapy and blood lipid abnormality: A case series with sixty patients. J Family Med Prim Care 2018; 7:171-174. [PMID: 29915754 PMCID: PMC5958563 DOI: 10.4103/jfmpc.jfmpc_104_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: prolonged isotretinoin therapy for various skin diseases causes change in various parameters of lipid profile. Aim: to find out the effect of low dose isotretinoin on various parameters of lipid profile. Methods: A clinic based observational study with 60 patients of various skin diseases carried out in a skin outpatient department of a tertiary care hospital in eastern India. Patients were prescribed isotretinoin for relevant indications. Baseline lipid profile was checked and repeated after three months. The results were compared with the baseline lipid levels. Result: Out of 60 patients (male-32, female-28) hyperlipidemia was present in 25% (15 out of 60) patients at the end of three month's therapy. Among the hyperlipidemia, hyper triglyceridemia was the commonest (16.67%, 10 out of 60 patients) followed by elevation of VLDL (11.67%, 7 out of 60 patients), elevation of LDL (10%, 6 out of 60), hypercholesterolemia (5%, 3 out of 60). Combination of hyperlipidemia was present in 11.67% patients. Among the male patients 28.12%, while in females 21.43% had hyperlipidemia at the end of the study. Among the hyperlipidemic females, hypertriglyceridemia was present in 83.3% (5 out of 6) of patients, while in male it was 55.5% (5 out of 9 patients). Conclusion: Low dose Isotretinoin therapy causes variable rise in various parameters of lipid profile. It should be used cautiously in patient with risk factors of metabolic syndrome and frequent monitoring of serum lipid profile is needed.
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Affiliation(s)
- Tanusree Sarkar
- Department of Dermatology, Burdwan Medical College, Burdwan, West Bengal, India
| | - Somenath Sarkar
- Department of Dermatology, B. S. Medical College, Bankura, West Bengal, India
| | - Aparesh Patra
- Department of Dermatology, Burdwan Medical College, Burdwan, West Bengal, India
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Vallerand IA, Lewinson RT, Farris MS, Sibley CD, Ramien ML, Bulloch AGM, Patten SB. Efficacy and adverse events of oral isotretinoin for acne: a systematic review. Br J Dermatol 2017; 178:76-85. [PMID: 28542914 DOI: 10.1111/bjd.15668] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2017] [Indexed: 01/01/2023]
Abstract
Despite many years of clinical use of isotretinoin, a comprehensive review of evidence for isotretinoin therapy in patients with acne is lacking. We searched MEDLINE, Embase, Cochrane Central, relevant web pages and bibliographies for randomized controlled trials in acne evaluating isotretinoin vs. control (placebo or other therapy). Data were extracted and summarized descriptively. Eleven trials were identified (total 760 patients randomized), containing mostly men. Mean treatment ages ranged from 18 to 47·9 years and participants generally had moderate-to-severe acne. Across all trials, isotretinoin therapy reduced acne lesion counts by a clinically relevant amount, and always by a greater amount than control, which was either placebo (two studies), oral antibiotics (seven studies) or other control (two studies). Across trials with an overall low risk of bias, two of three demonstrated statistically significant differences between isotretinoin and control. The frequency of adverse events was twice as high with isotretinoin (751 events) than with control (388 events). More than half of all adverse events were dermatological and related to dryness. Adverse events from isotretinoin causing participant withdrawal from trials (12 patients) included Stevens-Johnson syndrome, cheilitis, xerosis, acne flare, photophobia, elevated liver enzymes, decreased appetite, headaches and depressed mood. This review suggests that isotretinoin is effective in reducing acne lesion counts, but adverse events are common. This study was registered with PROSPERO number CRD42015025080.
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Affiliation(s)
- I A Vallerand
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - R T Lewinson
- Leaders in Medicine Program, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - M S Farris
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - C D Sibley
- Division of Dermatology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - M L Ramien
- Division of Dermatology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - A G M Bulloch
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Physiology & Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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21
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Petersen K, Regis DP. Safety of antimalarial medications for use while scuba diving in malaria Endemic Regions. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2017; 2:23. [PMID: 28883967 PMCID: PMC5530948 DOI: 10.1186/s40794-016-0041-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/07/2016] [Indexed: 11/24/2022]
Abstract
Background Recreational diving occurs annually in areas of the world where malaria is endemic. The safety and efficacy of antimalarials for travelers in a hyperbaric environment is unknown. Of particular concern would be medications with adverse effects that could either mimic diving related illnesses such as barotrauma, decompression sickness (DCS) and gas toxicities, or increase the risk for such illnesses. Methods We conducted a review of PubMed and Cochrane databases to determine rates of neurologic adverse effects or other effects from antimalarials that may be a problem in the diving environment. Results One case report was found on diving and mefloquine. Multiple case reports and clinical trials were found describing neurologic adverse effects of the major chemoprophylactic medications atovaquone/proguanil, chloroquine, doxycycline, mefloquine, and primaquine. Conclusions Of the available literature, atovaquone/proguanil and doxycycline are most likely the safest agents and should be preferred; atovaquone/proguanil is superior due to reduced rates of sunburn in the marine environment. Primaquine also appears to be safe, but has reduced efficacy against P. falciparum; mefloquine possesses the highest rate of neurologic side effects and therefore these agents should be limited to extreme cases of patients intolerant to other agents. Chloroquine appears unsafe in the hyperbaric environment and should be avoided. More studies are required to include database reviews of returned divers traveling to malaria endemic areas and randomized controlled trials in the hyperbaric environments.
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Affiliation(s)
- Kyle Petersen
- Department of Medicine, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, 4301 Jones Bridge Rd, Bethesda, MD 20814 USA
| | - David P Regis
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, 4301 Jones Bridge Rd, Bethesda, MD 20814 USA
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Abstract
PURPOSE To present a case of minocycline-induced blue scleral pigmentation and discuss the pathophysiology and differential diagnoses. The uses, mechanisms, and other adverse effects of minocycline will also be highlighted. CASE REPORT An elderly Caucasian male patient presented for routine ocular examination complaining of blue discoloration to the whites of his eyes. He was found to have bilateral blue scleral pigmentation and blue discoloration to various other dermal areas of his body. The blue pigmentation was also visible in the posterior segment within a scleral crescent around his right optic nerve. This pigmentation was determined to be caused by long-term use of oral minocycline. CONCLUSIONS Long-term minocycline use may induce scleral, dermal, and organ hyperpigmentation, typically blue or black in coloration. The pigmentation may reverse with discontinuation of the medication, but can also be permanent. The exact mechanism of pigment deposition remains uncertain, but several theories have been proposed. While the cosmetic appearance may be dramatic, this side effect is not known to cause any systemic or ocular morbidity.
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23
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Shuster J. Methotrexate Neurotoxicity Causes Speech Problem; Severe, Irreversible Sensory Neuropathy Due to Long-Term Use of Linezolid; Hypomania with Topiramate; Bortezomib-Induced Hepatitis; Steroid Dementia – An Overlooked Diagnosis?; Promethazine Warning; Medication Discrepancies at the Time of Hospital Admission; Medication-Induced Intracranial Hypertension. Hosp Pharm 2017. [DOI: 10.1177/001857870504000503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), to discuss methods of prevention, and to promote reporting of ADRs to the FDA's medWatch program (800-FDA-1088). If you have reported an interesting preventable ADR to medWatch, please consider sharing the account with our readers.
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Affiliation(s)
- Joel Shuster
- Temple University School of Pharmacy, Philadelphia, PA, Episcopal Hospital, Philadelphia; and Clinical Advisor and Trustee, Institute for Safe Medication Practices, Huntingdon Valley, PA 19006
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24
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Greywal T, Zaenglein AL, Baldwin HE, Bhatia N, Chernoff KA, Del Rosso JQ, Eichenfield LF, Levin MH, Leyden JJ, Thiboutot DM, Webster GF, Friedlander SF. Evidence-based recommendations for the management of acne fulminans and its variants. J Am Acad Dermatol 2017; 77:109-117. [DOI: 10.1016/j.jaad.2016.11.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/09/2016] [Accepted: 11/11/2016] [Indexed: 11/28/2022]
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Abstract
Severe, recalcitrant dermatologic conditions often require systemic treatment. Although efficacious, these medications have been associated with wide-ranging adverse reactions. Some are reversible, predictable, and either dose-dependent or treatment length-dependent, while others are unpredictable, irreversible, and potentially fatal. This review examines the neuropsychiatric adverse effects associated with US FDA-approved medications for treatment of the following dermatologic pathologies that typically require systemic therapy: autoimmune dermatoses, acne, psoriasis, and melanoma. A search of the literature was performed, with adverse effects ranging from mild headaches and neuropathy to severe encephalopathies. The medications associated with the most serious reactions were those used to treat psoriasis, especially the older non-biologic medications such as cyclosporine A and methotrexate. Given the importance of these systemic dermatologic therapies in treating severe, recalcitrant conditions, and the wide variety of potentially serious neuropsychiatric adverse effects of these medications, neurologists, psychiatrists, dermatologists, oncologists, and primary care providers must be aware of the potential for these neuropsychiatric adverse reactions to allow for appropriate counseling, management, and medication withdrawal.
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26
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Regen F, Le Bret N, Hildebrand M, Herzog I, Heuser I, Hellmann-Regen J. Inhibition of brain retinoic acid catabolism: a mechanism for minocycline's pleiotropic actions? World J Biol Psychiatry 2016; 17:634-640. [PMID: 26047390 DOI: 10.3109/15622975.2015.1036116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Minocycline is a tetracycline antibiotic increasingly recognized in psychiatry for its pleiotropic anti-inflammatory and neuroprotective potential. While underlying mechanisms are still incompletely understood, several lines of evidence suggest a relevant functional overlap with retinoic acid (RA), a highly potent small molecule exhibiting a great variety of anti-inflammatory and neuroprotective properties in the adult central nervous system (CNS). RA homeostasis in the adult CNS is tightly controlled through local RA synthesis and cytochrome P450 (CYP450)-mediated inactivation of RA. Here, we hypothesized that minocycline may directly affect RA homeostasis in the CNS via altering local RA degradation. METHODS We used in vitro RA metabolism assays with metabolically competent synaptosomal preparations from murine brain and human SH-SY5Y neuronal cells as well as viable human SH-SY5Y neuroblastoma cell cultures. RESULTS We revealed that minocycline potently blocks RA degradation as measured by reversed-phase high-performance liquid chromatography and in a viable RA reporter cell line, even at low micromolar levels of minocycline. CONCLUSIONS Our findings provide evidence for enhanced RA signalling to be involved in minocycline's pleiotropic mode of action in the CNS. This novel mode of action of minocycline may help in developing more specific and effective strategies in the treatment of neuroinflammatory or neurodegenerative disorders.
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Affiliation(s)
- F Regen
- a Department of Psychiatry , Section Clinical Neurobiology, Campus Benjamin Franklin, Charité,University Medicine Berlin , Germany
| | - N Le Bret
- a Department of Psychiatry , Section Clinical Neurobiology, Campus Benjamin Franklin, Charité,University Medicine Berlin , Germany
| | - M Hildebrand
- a Department of Psychiatry , Section Clinical Neurobiology, Campus Benjamin Franklin, Charité,University Medicine Berlin , Germany
| | - I Herzog
- a Department of Psychiatry , Section Clinical Neurobiology, Campus Benjamin Franklin, Charité,University Medicine Berlin , Germany
| | - I Heuser
- a Department of Psychiatry , Section Clinical Neurobiology, Campus Benjamin Franklin, Charité,University Medicine Berlin , Germany
| | - J Hellmann-Regen
- a Department of Psychiatry , Section Clinical Neurobiology, Campus Benjamin Franklin, Charité,University Medicine Berlin , Germany
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27
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Affiliation(s)
- Olga R. Thon
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - John W. Gittinger
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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28
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Ljubisavljević S, Zidverc Trajković J. Idiopathic Intracranial Hypertension – Pathophysiology Based on Case Series. ACTA FACULTATIS MEDICAE NAISSENSIS 2016. [DOI: 10.1515/afmnai-2016-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Summary
According to the definition, idiopathic intracranial hypertension (IIH) is a pathological state characterized by an increase in intracranial pressure; however, there are no obvious intracranial pathological processes. The pathophysiology of this disorder is not clear, although there are many reports related to it.
We present an overview of possible etiopathogenetic mechanisms, clinical presentations and therapeutic interventions from a series of patients hospitalized with the clinical picture and final diagnosis of idiopathic intracranial hypertension (IIH). All data were collected from the moment of IIH diagnosis as well as three months later.
The obtained data showed that IIH is a disease that primarily affects obese women in early and midlife. The positive correlation between values of cerebrospinal fluid pressure and body mass index was observed. The disorders of sexual hormones were identified as a possible etiology for IIH female patients. Headache, papilloedema, decreased visual acuity, vertigo and cranial nerve palsy were identified as the most prevalent IIH clinical presentations. The existence of stenosis and hypoplasia of the sigmoid and transverse sinus were confirmed only in one third of IIH patients. Pharmacotherapy combined with weight loss was efficacious in a large number of patients. In this series, there were no short-term consequences of IIH.
The results suggest the importance of early and accurate looking for IIH in obese early and midlife women with any hormonal imbalances having a variety of neurological expression, mostly presented as headaches and visual disturbances. Early detection of IIH might influence the timely treatment and prevent far-reaching and severe clinical consequences.
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29
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Marques P, Jacinto S, Pinto MDC, Limbert C, Lopes L. Diplopia, Convergent Strabismus, and Eye Abduction Palsy in a 12-Year-Old Boy with Autoimmune Thyroiditis. Case Rep Pediatr 2016; 2016:5823137. [PMID: 27379191 PMCID: PMC4917683 DOI: 10.1155/2016/5823137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 03/28/2016] [Indexed: 11/17/2022] Open
Abstract
Pseudotumor cerebri (PTC) is defined by clinical criteria of increased intracranial pressure, elevated intracranial pressure with normal cerebrospinal fluid (CSF) composition, and exclusion of other causes such tumors, vascular abnormalities, or infections. The association of PTC with levothyroxine (LT4) has been reported. A 12-year-old boy has been followed up for autoimmune thyroiditis under LT4. Family history was irrelevant for endocrine or autoimmune diseases. A TSH level of 4.43 μUI/mL (0.39-3.10) motivated a LT4 adjustment from 75 to 88 μg/day. Five weeks later, he developed horizontal diplopia, convergent strabismus with left eye abduction palsy, and papilledema. Laboratorial evaluation revealed elevated free thyroxine level (1.05 ng/dL [0.65-1.01]) and low TSH, without other alterations. Lumbar puncture was performed and CSF opening pressure was 24 cm H2O with normal composition. Blood and CSF cultures were sterile. Brain MRI was normal. LT4 was temporarily discontinued and progressive improvement was observed, with a normal fundoscopy at day 10 and reversion of diplopia one month later. LT4 was restarted at lower dose and gradually titrated. The boy is currently asymptomatic. This case discloses the potential role of LT4 in inducing PTC. Despite its rarity and unclear association, PTC must be seen as a potential complication of LT4, after excluding all other intracranial hypertension causes.
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Affiliation(s)
- Pedro Marques
- Department of Endocrinology, Instituto Português de Oncologia de Lisboa, Lisbon, Portugal
| | - Sandra Jacinto
- Department of Pediatric Neurology, Hospital Dona Estefânia, Lisbon, Portugal
| | - Maria do Carmo Pinto
- Adolescent Unit, Department of Pediatrics, Hospital Dona Estefânia, Lisbon, Portugal
| | - Catarina Limbert
- Pediatric Endocrinology Unit, Department of Pediatrics, Hospital Dona Estefânia, Lisbon, Portugal
| | - Lurdes Lopes
- Pediatric Endocrinology Unit, Department of Pediatrics, Hospital Dona Estefânia, Lisbon, Portugal
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30
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Law C, Yau GL, ten Hove M. Delayed Development of Intracranial Hypertension After Discontinuation of Tetracycline Treatment for Acne Vulgaris. J Neuroophthalmol 2016; 36:67-9. [DOI: 10.1097/wno.0000000000000301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Rigi M, Almarzouqi SJ, Morgan ML, Lee AG. Papilledema: epidemiology, etiology, and clinical management. Eye Brain 2015; 7:47-57. [PMID: 28539794 PMCID: PMC5398730 DOI: 10.2147/eb.s69174] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Papilledema is optic disc swelling due to high intracranial pressure. Possible conditions causing high intracranial pressure and papilledema include intracerebral mass lesions, cerebral hemorrhage, head trauma, meningitis, hydrocephalus, spinal cord lesions, impairment of cerebral sinus drainage, anomalies of the cranium, and idiopathic intracranial hypertension (IIH). Irrespective of the cause, visual loss is the feared morbidity of papilledema, and the main mechanism of optic nerve damage is intraneuronal ischemia secondary to axoplasmic flow stasis. Treatment is directed at correcting the underlying cause. In cases where there is no other identifiable cause for intracranial hypertension (ie, IIH) the available options include both medical and surgical modalities. Weight loss and diuretics remain the mainstays for treatment of IIH, and surgery is typically reserved for patients who fail, are intolerant to, or non-compliant with maximum medical therapy.
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Affiliation(s)
| | | | - Michael L Morgan
- Department of Ophthalmology, Houston Methodist Hospital, Blanton Eye Institute
| | - Andrew G Lee
- Department of Ophthalmology, Houston Methodist Hospital, Blanton Eye Institute.,Baylor College of Medicine.,Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, UTMB Galveston, UT MD Anderson Cancer Center, Houston, TX, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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32
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Aispuru G, Pascual-Pablo E. Hipertensión intracraneal idiopática asociada a exceso dietario de vitamina A. Semergen 2015; 41:e24-6. [DOI: 10.1016/j.semerg.2014.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/27/2014] [Accepted: 05/31/2014] [Indexed: 10/25/2022]
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Blasco Morente G, Tercedor Sánchez J, Garrido Colmenero C, Martínez García E, Molina-Carballo A. Pseudotumor cerebri associated with cyclosporine use in severe atopic dermatitis. Pediatr Dermatol 2015; 32:237-9. [PMID: 24330027 DOI: 10.1111/pde.12273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Cyclosporine use can cause neurologic complications in 0.5% to 35% of cases, although the appearance of pseudotumor cerebri (PC) is exceptional. PC secondary to the use of cyclosporine is described mainly in individuals who have received a bone marrow transplant. We report the first case, to our knowledge, of PC secondary to the use of cyclosporine in a child with severe atopic dermatitis, with satisfactory resolution and without vision sequelae.
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Affiliation(s)
- Gonzalo Blasco Morente
- Department of Dermatology and Venereology, Virgen de las Nieves Hospital, Granada, Spain
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Hellmann-Regen J, Herzog I, Fischer N, Heuser I, Regen F. Do tetracyclines and erythromycin exert anti-acne effects by inhibition of P450-mediated degradation of retinoic acid? Exp Dermatol 2015; 23:290-3. [PMID: 24690039 DOI: 10.1111/exd.12358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2014] [Indexed: 12/26/2022]
Abstract
For decades, retinoic acid (RA) is known as the most potent therapeutic option in the therapy of acne and altered homeostasis of endogenous retinoids has been discussed in the context of acne pathogenesis. Besides retinoids, antibiotics such as tetracyclines or erythromycin are well established in acne pharmacotherapy. Accumulating evidence points towards common molecular pathways being targeted by both RA and anti-acne antibiotics; however, a precise 'common denominator' connecting these chemically diverse anti-acne agents has not yet been identified. Interestingly, tetracyclines are associated with the occurrence of pseudotumor cerebri, a rare neurological side effect otherwise associated with retinoid intoxication or RA exposure. This association at the clinical level suggests an interaction between tetracyclines and endogenous RA signalling. As erythromycin does not cross the blood brain barrier, CNS side effects are not to be expected, yet not precluding a possible local interaction of erythromycin with endogenous RA metabolism in the skin. We hypothesize tetracyclines and erythromycin to locally inhibit endogenous RA metabolism in the skin and thus mimic therapeutic action of RA. This readily testable hypothesis suggests inhibition of endogenous RA metabolism and amplification of endogenous RA signalling as a mechanism underlying the biochemical actions of antibiotics in acne therapy. Elucidation of such interactions may ultimately enhance our understanding of acne therapy and pathogenesis and may yield a sound, scientific basis for hypothesis-driven development of novel therapeutic compounds.
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Affiliation(s)
- Julian Hellmann-Regen
- Clinical Neurobiology, Department of Psychiatry, Charité University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany
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35
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Paley GL, Sheldon CA, Burrows EK, Chilutti MR, Liu GT, McCormack SE. Overweight and obesity in pediatric secondary pseudotumor cerebri syndrome. Am J Ophthalmol 2015; 159:344-52.e1. [PMID: 25447107 DOI: 10.1016/j.ajo.2014.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/30/2014] [Accepted: 11/01/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To examine the clinical, demographic, and anthropometric patient characteristics of secondary pseudotumor cerebri syndrome in children and adolescents based on the recently revised diagnostic criteria. DESIGN Retrospective observational case series. METHODS Patients seen at a tertiary children's hospital for pseudotumor cerebri syndrome were classified as having either primary idiopathic (n = 59) or secondary pseudotumor cerebri syndrome (n = 16), as rigorously defined by recently revised diagnostic criteria. Outcomes included body mass index Z-scores (BMI-Z), height and weight Z-scores, demographics, and clinical features at presentation, such as headache, sixth nerve palsy, and cerebrospinal fluid (CSF) opening pressure. RESULTS In this cohort, the associated conditions and exposures seen in definite secondary pseudotumor cerebri syndrome included tetracycline-class antibiotics (n = 11), chronic kidney disease (n = 3), withdrawal from chronic glucocorticoids (n = 1), and lithium (n = 1). Other associations observed in the possible secondary pseudotumor cerebri syndrome group included Down syndrome, vitamin A derivatives, and growth hormone. In comparison with primary pseudotumor cerebri syndrome, definite secondary pseudotumor cerebri syndrome patients were on average older (15.0 vs 11.6 years; P = .003, Mann-Whitney test). According to US Centers for Disease Control (CDC) classifications, 79% of children with secondary pseudotumor cerebri syndrome were either overweight or obese (36% overweight [n = 5] and 43% obese [n = 6]), as compared to 32% nationally. CONCLUSIONS Even when a potential inciting exposure is identified for pediatric pseudotumor cerebri syndrome, the possible contribution of overweight and obesity should be considered.
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36
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Clinical characterization of idiopathic intracranial hypertension in children presenting to the emergency department: the experience of a large tertiary care pediatric hospital. Pediatr Emerg Care 2015; 31:6-9. [PMID: 25207755 DOI: 10.1097/pec.0000000000000177] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a syndrome characterized by elevated intracranial pressure, without evidence of intracranial mass lesion or venous thrombosis on brain imaging. The syndrome occurs mainly in young, fertile, and overweight women but may present in any age group. The aim of this study was to report the presentation, course, and outcomes of older versus younger children presenting with IIH to the emergency department of our large tertiary care hospital during an 8-year period. METHODS Retrospective chart review (January 2000-December 2008) of all patients younger than 17 years with IIH was performed on the basis of modified Dandy Criteria. The patients were analyzed according to age (<11 years and 11-17 years) and weight centile (<90%, 90%-97%, >97%). RESULTS Ages ranged from 2 to 16.5 years (mean [SD], 9.71 [4.56] years). Thirty males (46.8%) and 33 females (53.2%) were identified: 30 were prepubertal with a male-female ratio of 1:0.56 and 33 were pubertal with a male-female ratio of 1:2 (P < 0.05). There were no significant differences between the 2 age groups in proportions of children in the 3 predefined weight categories The most common presenting symptom was headache (75%), which was significantly less common in the younger age group compared with the older group (P < 0.01). Papilledema was present in 51 patients (82.3%). Mean (SD) cerebrospinal fluid opening pressure was 378 (16) mm H2O. Findings of brain imaging (mostly computed tomographic scan), performed in all patients, were normal in 42 (67.7%); the most common finding in the remainder was swelling of the optic nerves. CONCLUSIONS Our results indicate that IIH should be considered in any child with new-onset headache or visual disturbance, irrespective of age, sex, weight, or the presence of known predisposing factors. When IIH is suspected, neuroimaging should be performed promptly to exclude secondary causes of this condition because IIH in children remains a diagnosis of exclusion. Early diagnosis and prompt treatment for IIH can prevent potential visual loss.
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Frew JW. The clinical significance of drug interactions between dermatological and psychoactive medications. Dermatol Ther 2014; 27:1-11. [PMID: 24502302 DOI: 10.1111/dth.12003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Dermatological disease is commonly associated with psychological morbidity because of its visible nature. The burden of living with a chronic dermatological illness can contribute to the development of psychiatric illness and conversely, such conditions can result in the exacerbation of preexisting dermatological disease. It may also reduce a patient's compliance to treatment, result in loss to follow-up and a decreased level of functioning and quality of life. In dermatological patients who suffer from psychiatric symptoms, medical management used in their treatment may have significant interactions with systemic medications used to treat their dermatological condition. A well-known example of this is lithium's ability to exacerbate psoriasis. Such interactions can result in suboptimal treatment of their psychiatric and/or dermatological condition. The present paper aimed to review the literature for documented interactions and the level of clinical significance between dermatological and psychoactive medications. Such information is clinically relevant to the practicing dermatologist in order to minimize adverse effects and drug-drug interactions in dermatological patients.
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Affiliation(s)
- John W Frew
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Ramana Reddy AM, Prashanth LK, Sharat Kumar GG, Chandana G, Jadav R. Over-the-counter self-medication leading to intracranial hypertension in a young lady. J Neurosci Rural Pract 2014; 5:384-6. [PMID: 25288841 PMCID: PMC4173236 DOI: 10.4103/0976-3147.139991] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Intracranial hypertension (idiopathic-IIH and secondary) is a potentially treatable condition. Although various factors such as female gender and obesity, certain drugs have been implicated as risk factors for IIH, there remains a lack of clarity in the exact causal–effect relationship. In India, self-medication by obtaining drugs over the counter due to lack of adequate drug regulation and ignorance of the public is a very common practice with a potential for severe adverse effects. We present a case of a young lady who has developed intracranial hypertension possibly due to self-medication with steroids and cyproheptadine, obtained over the counter.
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Affiliation(s)
- A M Ramana Reddy
- Advanced Neurosciences Institute, BGS Global Hospital, Bangalore, Karnataka, India
| | - L K Prashanth
- Advanced Neurosciences Institute, BGS Global Hospital, Bangalore, Karnataka, India
| | - G G Sharat Kumar
- Advanced Neurosciences Institute, BGS Global Hospital, Bangalore, Karnataka, India
| | - G Chandana
- Advanced Neurosciences Institute, BGS Global Hospital, Bangalore, Karnataka, India
| | - Rakesh Jadav
- Advanced Neurosciences Institute, BGS Global Hospital, Bangalore, Karnataka, India
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Almarzouqi SJ, Morgan ML, Lee AG. Idiopathic intracranial hypertension in the Middle East: A growing concern. Saudi J Ophthalmol 2014; 29:26-31. [PMID: 25859136 DOI: 10.1016/j.sjopt.2014.09.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 09/10/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022] Open
Abstract
Idiopathic Intracranial Hypertension (IIH) is a disorder of increased intracranial pressure without any identifiable etiology. It is defined by elevated intracranial pressure (ICP) with normal neuroimaging and normal cerebrospinal fluid (CSF) contents. IIH typically affects young obese women and produces symptoms and signs related to high ICP. Headache and blurred vision are the most common symptoms, and papilledema is the major clinical sign. In this review we examine the epidemiology and demographic features of IIH in Middle Eastern countries and compare and contrast them with the published IIH literature from Western countries. The incidence of IIH in several Middle East countries has been estimated at 2.02-2.2/100,000 in the general population, which is higher than the Western rate. Obesity is a major risk factor globally and it is associated with an increased risk of severe vision loss due to IIH. There has been an increase in obesity prevalence in the Middle East countries mainly affecting the Gulf Council Countries (GCC), which parallels increased industrial development. This rise may be contributing to the increasing incidence of IIH in these countries. Other risk factors may also be contributing to IIH in Middle East countries and the differences and similarities to Western IIH merit further study.
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Affiliation(s)
- Sumayya J Almarzouqi
- Department of Ophthalmology, Houston Methodist Hospital, Houston, TX, United States
| | - Michael L Morgan
- Department of Ophthalmology, Houston Methodist Hospital, Houston, TX, United States
| | - Andrew G Lee
- Department of Ophthalmology, Houston Methodist Hospital, Houston, TX, United States ; Baylor College of Medicine, Houston, TX, United States ; Department of Ophthalmology, Weill Cornell Medical College, Houston, TX, United States ; Department of Neurology, Weill Cornell Medical College, Houston, TX, United States ; Department of Neurosurgery, Weill Cornell Medical College, Houston, TX, United States ; UTMB, Galveston, TX, United States ; UT M.D. Anderson Cancer Center, Houston, TX, United States ; The University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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Abstract
Acne is a common skin condition in adolescents. It is not uncommon in childhood and it persists into adulthood. A broad range of acne treatments are available and have been shown to be safe and effective in adolescents and adults. However, there is limited literature regarding acne treatment in childhood and its available therapeutic options. It seems reasonable to extrapolate findings of the various studies reported on treatment of acne in the adolescent and adult age group, with the exclusion of the use of tetracycline derivatives. As clinicians, we must be more familiar with the clinical presentation of acne and available treatment options in our younger patients. Early recognition of acne with prompt and appropriate initiation of therapy in childhood will help prevent severe scarring in children.
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McGeeney BE, Friedman DI. Pseudotumor Cerebri Pathophysiology. Headache 2014; 54:445-58. [DOI: 10.1111/head.12291] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2013] [Indexed: 12/12/2022]
Affiliation(s)
| | - Deborah I. Friedman
- Neurology & Neurotherapeutics and Ophthalmology; University of Texas Southwestern Medical Center; Dallas TX USA
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Ravikumar M, Hageman DJ, Tomaszewski WH, Chandra GM, Skousen JL, Capadona JR. The Effect of Residual Endotoxin Contamination on the Neuroinflammatory Response to Sterilized Intracortical Microelectrodes. J Mater Chem B 2014; 2:2517-2529. [PMID: 24778808 DOI: 10.1039/c3tb21453b] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A major limitation to the use of microelectrode technologies in both research and clinical applications is our inability to consistently record high quality neural signals. There is increasing evidence that recording instability is linked, in part, to neuroinflammation. A number of factors including extravasated blood products and macrophage released soluble factors are believed to mediate neuroinflammation and the resulting recording instability. However, the roles of other inflammatory stimuli, such as residual endotoxin contamination, are poorly understood. Therefore, to determine the effect of endotoxin contamination we examined the brain tissue response of C57/BL6 mice to non-functional microelectrodes with a range of endotoxin levels. Endotoxin contamination on the sterilized microelectrodes was measured using a limulus amebocyte lysate test following FDA guidelines. Microelectrodes sterilized by autoclave, dry heat, or ethylene oxide gas, resulted in variable levels of residual endotoxins of 0.55 EU/mL, 0.22 EU/mL, and 0.11 EU/mL, respectively. Histological evaluation at two weeks showed a direct correlation between microglia/macrophage activation and endotoxin levels. Interestingly, astrogliosis, neuronal loss, and blood brain barrier dysfunction demonstrated a threshold-dependent response to bacterial endotoxins. However, at sixteen weeks, no histological differences were detected, regardless of initial endotoxin levels. Therefore, our results demonstrate that endotoxin contamination, within the range examined, contributes to initial but not chronic microelectrode associated neuroinflammation. Our results suggest that minimizing residual endotoxins may impact early recording quality. To this end, endotoxins should be considered as a potent stimulant to the neuroinflammatory response to implanted intracortical microelectrodes.
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Affiliation(s)
- Madhumitha Ravikumar
- Case Western Reserve University, Department of Biomedical Engineering, 2071 Martin Luther King Jr. Drive, Wickenden Building, Cleveland, OH, 44106, USA
| | - Daniel J Hageman
- Case Western Reserve University, Department of Biomedical Engineering, 2071 Martin Luther King Jr. Drive, Wickenden Building, Cleveland, OH, 44106, USA
| | - William H Tomaszewski
- Case Western Reserve University, Department of Biomedical Engineering, 2071 Martin Luther King Jr. Drive, Wickenden Building, Cleveland, OH, 44106, USA
| | - Gabriella M Chandra
- Case Western Reserve University, Department of Biomedical Engineering, 2071 Martin Luther King Jr. Drive, Wickenden Building, Cleveland, OH, 44106, USA
| | - John L Skousen
- Case Western Reserve University, Department of Biomedical Engineering, 2071 Martin Luther King Jr. Drive, Wickenden Building, Cleveland, OH, 44106, USA
| | - Jeffrey R Capadona
- Case Western Reserve University, Department of Biomedical Engineering, 2071 Martin Luther King Jr. Drive, Wickenden Building, Cleveland, OH, 44106, USA
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Regen F, Heuser I, Herzog I, Hellmann-Regen J. Striking growth-inhibitory effects of minocycline on human prostate cancer cell lines. Urology 2013; 83:509.e1-6. [PMID: 24360070 DOI: 10.1016/j.urology.2013.10.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 10/14/2013] [Accepted: 10/21/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To elucidate a hypothetical link between retinoic acid (RA) signaling and minocycline for targeting prostate carcinoma (PCA). RA signaling has been implicated in growth-inhibition of malignant PCA, and intracellular RA homeostasis has been investigated as a potential therapeutic target. Minocycline is a tetracycline antibiotic with pleiotropic actions in many tissues and reaches comparably high levels in human prostate tissue. Interestingly, minocycline exhibits the rare side effect of a pseudotumor cerebri, which is otherwise known to occur from vitamin A intoxication or in retinoid therapy. Therefore, we hypothesized minocycline to putatively interact with intracellular RA homeostasis in PCA. METHODS Using LN-CAP, DU-145, and PC-3 cell lines, effects of minocycline on microsomal RA metabolism and on cell growth were assessed in vitro. RESULTS Minocycline was identified to potently inhibit cell growth, at concentrations within the range of tissue levels readily reached under standard therapeutic conditions. In vitro inhibition experiments revealed inhibition of RA breakdown, yet only at comparably high concentrations of minocycline. Using all trans-RA, RA metabolism inhibitor liarozole, and different retinoid receptor antagonists, the putative RA-dependent effects of minocycline were further evaluated and confirmed to be independent of RA signaling. CONCLUSION Our findings add to the growing body of evidence for the many pleiotropic actions of minocycline. In view of the striking effects of minocycline on cell growth in PCA cell lines in vitro and its relatively safe side effect profile, the use of minocycline for targeting PCA should be timely clinically evaluated.
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Affiliation(s)
- Francesca Regen
- Department of Psychiatry, Clinical Neurobiology, Charité - Campus Benjamin Franklin, Berlin, Germany
| | - Isabella Heuser
- Department of Psychiatry, Clinical Neurobiology, Charité - Campus Benjamin Franklin, Berlin, Germany
| | - Irmelin Herzog
- Department of Psychiatry, Clinical Neurobiology, Charité - Campus Benjamin Franklin, Berlin, Germany
| | - Julian Hellmann-Regen
- Department of Psychiatry, Clinical Neurobiology, Charité - Campus Benjamin Franklin, Berlin, Germany.
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Reiss RM, Breden Crouse EL. Pharmacist's guide to pseudotumor cerebri: A review of the condition and its management. Ment Health Clin 2013. [DOI: 10.9740/mhc.n178413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rebecca M. Reiss
- 1PGY2 Psychiatric Pharmacy Resident, Virginia Commonwealth University, Health System, Richmond, VA
| | - Ericka L. Breden Crouse
- 2Clinical Pharmacy Specialist, Psychiatry Virginia Commonwealth University, Health System, Richmond, VA
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Stiebel-Kalish H, Eyal S, Steiner I. The role of aquaporin-1 in idiopathic and drug-induced intracranial hypertension. Med Hypotheses 2013; 81:1059-62. [PMID: 24169407 DOI: 10.1016/j.mehy.2013.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 09/27/2013] [Accepted: 10/04/2013] [Indexed: 10/26/2022]
Abstract
Idiopathic intracranial hypertension is a common disorder affecting mainly healthy, young, overweight women. The pathogenesis of this condition is unknown, but it has been shown to follow treatment with several compounds including corticosteroids and vitamin A derivatives. This paper will offer a novel hypothesis and insight on the pathogenesis of drug induced intracranial hypertension following a review and analysis of the literature. Both corticosteroids and vitamin A derivatives have been shown to upregulate the expression of aquaporin 1, a water channel protein. Aquaporin 1 is widely distributed in the human brain and is associated with water secretion into the subarachnoid space. Aquaporin 1 was also shown to participate in the regulation of weight. Agents used for treating idiopathic intracranial hypertension reduce aquaporin 1 expression. Based on these observations, we propose that aquaporin 1 has a pathogenetic role in drug induced idiopathic intracranial hypertension. Over expression of this gene causes increased intracranial pressure, and downregulation reduces pressure and alleviates the symptomatology and complications of idiopathic intracranial hypertension.
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Affiliation(s)
- H Stiebel-Kalish
- Department of Ophthalmology, Neuro-Ophthalmology Unit, Rabin Medical Center, Petach Tikva 49100, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
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Abstract
In the bewildering array of scientific nomenclature in the medical field, it is important to use correct terminology, know their aberrations and the reason behind a specific terminology. This paper is an attempt towards compiling all the pseudo-nomenclatures coined in dermatology, in order to make it easier to retain and recollect these pseudo names, signs, morphology, diseases, and conditions. It is also imperative to know the true entities that these pseudo names masquerade as, so as to understand the explanation for assigning the term 'pseudo' to these conditions. A total of 52 pseudo-terms have been compiled here in reference to dermatology. Most of these pseudo-nomenclatures were coined due to some clinical or histopathological resemblance to the true conditions, while some were premature conclusions drawn from a flawed understanding of the basic nature of the condition. Clear understanding of each of these terms and the explanation behind them being pseudo will enable a dermatologist to avoid misdiagnosis and needless confusion.
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Affiliation(s)
- Sangita Ghosh
- Department of Skin and V.D., PGIMS, Rohtak, Haryana, India
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Eichenfield LF, Krakowski AC, Piggott C, Del Rosso J, Baldwin H, Friedlander SF, Levy M, Lucky A, Mancini AJ, Orlow SJ, Yan AC, Vaux KK, Webster G, Zaenglein AL, Thiboutot DM. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics 2013; 131 Suppl 3:S163-86. [PMID: 23637225 DOI: 10.1542/peds.2013-0490b] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Acne vulgaris is one of the most common skin conditions in children and adolescents. The presentation, differential diagnosis, and association of acne with systemic pathology differs by age of presentation. Current acknowledged guidelines for the diagnosis and management of pediatric acne are lacking, and there are variations in management across the spectrum of primary and specialty care. The American Acne and Rosacea Society convened a panel of pediatric dermatologists, pediatricians, and dermatologists with expertise in acne to develop recommendations for the management of pediatric acne and evidence-based treatment algorithms. METHODS Ten major topic areas in the diagnosis and treatment of pediatric acne were identified. A thorough literature search was performed and articles identified, reviewed, and assessed for evidence grading. Each topic area was assigned to 2 expert reviewers who developed and presented summaries and recommendations for critique and editing. Furthermore, the Strength of Recommendation Taxonomy, including ratings for the strength of recommendation for a body of evidence, was used throughout for the consensus recommendations for the evaluation and management of pediatric acne. Practical evidence-based treatment algorithms also were developed. RESULTS Recommendations were put forth regarding the classification, diagnosis, evaluation, and management of pediatric acne, based on age and pubertal status. Treatment considerations include the use of over-the-counter products, topical benzoyl peroxide, topical retinoids, topical antibiotics, oral antibiotics, hormonal therapy, and isotretinoin. Simplified treatment algorithms and recommendations are presented in detail for adolescent, preadolescent, infantile, and neonatal acne. Other considerations, including psychosocial effects of acne, adherence to treatment regimens, and the role of diet and acne, also are discussed. CONCLUSIONS These expert recommendations by the American Acne and Rosacea Society as reviewed and endorsed by the American Academy of Pediatrics constitute the first detailed, evidence-based clinical guidelines for the management of pediatric acne including issues of special concern when treating pediatric patients.
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Affiliation(s)
- Lawrence F Eichenfield
- Division of Pediatric and Adolescent Dermatology, Rady Children's Hospital, San Diego and Department of Pediatrics, University of California, San Diego, San Diego, California, USA.
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Galgano MA, Deshaies EM. An update on the management of pseudotumor cerebri. Clin Neurol Neurosurg 2013; 115:252-9. [DOI: 10.1016/j.clineuro.2012.11.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 10/19/2012] [Accepted: 11/25/2012] [Indexed: 11/28/2022]
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Idiopathic intracranial hypertension: Diagnosis, monitoring and treatment. Rev Neurol (Paris) 2012; 168:673-83. [PMID: 22981270 DOI: 10.1016/j.neurol.2012.07.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 07/17/2012] [Accepted: 07/19/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Idiopathic intracranial hypertension (IIH) is a disorder typically affecting young, obese women, producing a syndrome of increased intracranial pressure without identifiable cause. STATE OF THE ART Despite a large number of hypotheses and publications over the past decade, the etiology of IIH is still unknown. There continues to be no evidence-based consensus or formal guidelines regarding management and treatment of the disease. Treatment studies show that the diagnostic lumbar puncture is a valuable intervention beyond its diagnostic importance, and that weight management is critical. However, many questions remain, regarding the efficacy of acetazolamide, cerebrospinal fluid (CSF) shunting procedures, optic nerve sheath fenestration, and cerebral transverse venous sinus stenting. Identification of subgroups of patients at high-risk for irreversible visual loss, such as black patients, men, morbidly obese patients, and patients with fulminant IIH, helps determine management approaches and refine follow-up strategies. PERSPECTIVE Better understanding of the pathophysiology and ongoing clinical trials will hopefully help inform treatment strategies over the next few years.
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All-Trans Retinoic Acid-Induced Pseudotumor Cerebri during Induction Therapy for Acute Promyelocytic Leukemia: A Case Report and Literature Review. Case Rep Oncol Med 2012; 2012:313057. [PMID: 22701192 PMCID: PMC3371673 DOI: 10.1155/2012/313057] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Accepted: 04/01/2012] [Indexed: 12/22/2022] Open
Abstract
All-trans retinoic acid (ATRA), a derivative of vitamin A, is an essential component in the treatment of acute promyelocytic leukemia (APL). Though considered to be a relatively safe drug, use of ATRA can lead to several side effects such as retinoic acid syndrome and pseudotumor cerebri (PC). PC is a rare disorder characterized by neurologic and ocular signs and symptoms of increased intracranial pressure, but with normal cerebrospinal fluid composition and normal brain imaging. Most of the previous studies suggest that PC, as a complication of ATRA therapy, occurs predominantly in the pediatric age group. Herein, we report a rare case of ATRA-induced PC in a 38-year-old woman undergoing induction treatment for APL. Symptoms improved with discontinuation of ATRA and treatment with acetazolamide. Concomitant administration of medications such as triazole antifungals which influence the cytochrome P-450 system can exacerbate this potential complication of ATRA. In this paper, we also review the current literature, provide a descriptive analysis of clinical features, and discuss the principles of management of ATRA-induced PC.
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