Increased Incidence of Pseudotumor Cerebri Syndrome Among Users of Tetracycline Antibiotics

BACKGROUND

To determine whether the use of a tetracycline-class antibiotic is associated with an increased risk of developing pseudotumor cerebri syndrome (PTCS).

METHODS

We identified patients in the University of Utah Health system who were prescribed a tetracycline-class antibiotic and determined what percentage of those individuals were subsequently diagnosed with PTCS secondary to tetracycline use. We compared this calculation to the number of patients with PTCS unrelated to tetracycline use.

RESULTS

Between 2007 and 2014, a total of 960 patients in the University system between the ages of 12 and 50 were prescribed a tetracycline antibiotic. Among those, 45 were diagnosed with tetracycline-induced PTCS. We estimate the incidence of tetracycline-induced PTCS to be 63.9 per 100,000 person-years. By comparison, the incidence of idiopathic intracranial hypertension (IIH) is estimated to be less than one per 100,000 person-years (Calculated Risk Ratio = 178).

CONCLUSIONS

Although a causative link between tetracycline use and pseudotumor cerebri has yet to be firmly established, our study suggests that the incidence of pseudotumor cerebri among tetracycline users is significantly higher than the incidence of IIH in the general population.

A Comparison Between the Clinical Features of Pseudotumor Cerebri Secondary to Tetracyclines and Idiopathic Intracranial Hypertension

PURPOSE

Comparisons between clinical features of tetracycline-induced pseudotumor cerebri (PTC-T) and those of idiopathic intracranial hypertension (IIH) are absent in the literature. We hypothesized that significant clinical differences between these etiologies exist and could be better understood by retrospective analysis.

DESIGN

Retrospective cohort study.

METHODS

We reviewed patients diagnosed with pseudotumor cerebri syndrome (PTCS) at our center and identified those who developed PTC-T after treatment with a tetracycline-class antibiotic and those with IIH. Groups were compared by demographics, body mass index, ophthalmic examination, treatment, clinical course, and visual outcomes.

RESULTS

We identified 52 cases of PTC-T and 302 cases of IIH. Obesity rates were significantly different (43.8% for PTC-T vs 79.2% for IIH, P < .001). The mean age at diagnosis was younger for PTC-T (19.8 years vs 28.1 years for IIH, P < .001). Diplopia was more common with PTC-T (40.4% vs 20.1% for IIH, P = .001). The mean illness duration was shorter for PTC-T (18.3 weeks vs 62.9 weeks for IIH, P <.0001). Recurrence rates were significantly different (4.0% for PTC-T vs 16.5% for IIH, P <.001). The frequency of surgical intervention was similar. Vision loss was uncommon but occurred with similar frequency.

CONCLUSION

We identified significant clinical differences but also identified important similarities between the 2 groups. There appear to be nonobese patients who develop PTC-T, discontinue the antibiotic, and never develop PTCS again. There are other patients who develop PTC-T, discontinue the antibiotic, and later develop IIH. We conclude that PTC-T represents a spectrum of disease in susceptible individuals.

The Armstrong Laboratory Aviation Personality Survey: development, norming, and validation

This work describes the development of a new psychological test for aviators. The Armstrong Laboratory Aviation Personality Survey was developed through the integration of clinical theory, psychometric methods, and empirical testing. It is currently given to all incoming U.S. Air Force pilot candidates. Using a sample of 6,047 student pilots, a thorough test development plan was accomplished. The 15 final test scales assess personality, psychopathology, and crew interaction styles. The scales have normative data and are demonstrated to be reliable and valid. The Armstrong Laboratory Aviation Personality Survey is recommended for use in the aviation community for both clinical and research purposes. Future research is recommended and needed in the areas of training, airframe, and special duty selection. Additional clinical work is indicated in the areas of psychiatric, psychological, and aeromedical evaluations.

The pre-intake drop-out at a community mental health center

Characteristics of patients who failed to appear for their intake interviews at a community mental health center were contrasted with those who did follow through with their appointments. Findings suggest that characteristics associated with dropping out are likely to vary with patient groups. Show rates for adults who were seeking help for themselves were significantly related to parental status and the length of time from the day of scheduling an intake interview until that appointment. Patient-therapist gender matches were related to the probability of children showing for intake interviews.