1. A Comparison Between the Clinical Features of Pseudotumor Cerebri Secondary to Tetracyclines and Idiopathic Intracranial Hypertension
- Author
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Orme, Daniel R., Miller, Matthew A., Warner, Judith E. A., Moran, John A., Bair, Christopher, McFadden, Molly, Crum, Alison Voigt, Katz, Bradley J., and Digre, Kathleen B.
- Subjects
Adult ,Diagnostic Imaging ,Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,endocrine system diseases ,Pseudotumor cerebri ,Disease ,Article ,Body Mass Index ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Young adult ,Child ,Retrospective Studies ,030304 developmental biology ,Pseudotumor Cerebri ,0303 health sciences ,business.industry ,Clinical course ,Retrospective cohort study ,Middle Aged ,Tetracycline ,medicine.disease ,Anti-Bacterial Agents ,Ophthalmology ,030221 ophthalmology & optometry ,Etiology ,Female ,business ,Body mass index ,After treatment ,Follow-Up Studies - Abstract
BACKGROUND-: A comparison between the clinical features of tetracycline-induced pseudotumor cerebri (PTC-T) and those of idiopathic intracranial hypertension (IIH) is absent in the literature. We hypothesized that significant clinical differences between these two etiologies do exist and could be better understood by thoroughly analyzing signs, symptoms, and patient demographics. METHODS-: We retrospectively reviewed charts of patients who were evaluated for pseudotumor cerebri syndrome (PTCS) at a single neuro-ophthalmic referral center. We identified patients who developed PTC-T after therapy with minocycline, doxycycline, and tetracycline, as well as patients with IIH. All patients met the recently revised diagnostic criteria for PTCS. Patients with PTC-T and IIH were compared by demographics, body mass index (BMI), visual exam at presentation, treatment, course of illness, and visual outcomes. RESULTS-: We identified 52 cases of PTC-T and 302 cases of IIH. Minocycline was identified as the causative tetracycline antibiotic in 41 of 52 cases of PTC-T (78.8%). Obesity rates among the two groups (PTC-T vs. IIH) were 43.8% vs. 79.2% (P < 0.001). Mean age at diagnosis was 19.8 vs. 28.1 years (P < 0.001). Diplopia occurred at a rate of 40.4% vs. 20.1% (P = 0.001). Mean duration of illness was found to be 18.3 vs. 62.9 weeks (P < 0.0001). Recurrence rates among the two groups were 4.0% vs. 16.5% (P < 0.001). CONCLUSION-: We identified several significant clinical differences between PTC-T and IIH. PTC-T patients tend to be younger, often non-obese, and more likely to experience diplopia. Disease recurrence is less frequently seen with PTC-T than IIH. The frequency of aggressive treatments between the two groups (e.g. shunting procedures and optic nerve sheath fenestrations) was found to be similar. Vision loss, while uncommon, occurs with similar frequency, despite a significantly shorter duration of illness in PTC-T. Recognition of these important clinical differences may help guide further investigation into the poorly-understood pathogenesis of IIH and PTC-T.
- Published
- 2020