minocycline and Intracranial-Hypertension

Catheter-related infection of the cerebrospinal fluid (CSF) pathways is a potentially life-threatening complication of external ventricular drainage. A major source of infection is bacterial contamination along the external ventricular drain (EVD) catheter track. The authors examined the efficacy of EVD catheters impregnated with minocycline and rifampin in preventing these catheter-related infections.. The authors conducted a prospective, randomized clinical trial at six academic medical centers. All hospitalized patients 18 years or older who required placement of an EVD catheter were eligible for inclusion in the study. Patients were randomly assigned to undergo placement of an EVD with a catheter impregnated with minocycline and rifampin or a standard untreated catheter (control group). To assess primary outcome, CSF samples were collected using a sterile technique at the time of catheter insertion, at least every 72 hours while the catheter remained in place, and at the time of catheter removal. At the time of removal, CSF cultures were obtained from the tip and tunneled segments of each catheter by performing semiquantitative roll-plate and quantitative sonication techniques. Of the 306 patients enrolled in the study, data from 288 were included in the final analysis. Eighteen patients were excluded from analysis: 14 because the ventricular catheter was in place less than 24 hours, and four because CSF cultures obtained at the time of catheter insertion were positive for infection. Of these 288 patients, 139 were assigned to the control group and 149 to the treatment group. The two groups were well matched with respect to all clinical characteristics, including patient sex and mean age, indication for catheter placement, and length of time the catheter remained in place. The antibiotic-impregnated catheters were one half as likely to become colonized as the control catheters (17.9 compared with 36.7%, respectively, p < 0.0012). Positive CSF cultures were seven times less frequent in patients with antibiotic-impregnated catheters compared with those in the control group (1.3 compared with 9.4%, respectively, p = 0.002).. The use of EVD catheters impregnated with minocycline and rifampin can significantly reduce the risk of catheter-related infections.

Topics: Anti-Infective Agents, Local; Bacterial Infections; Brain Injuries; Catheters, Indwelling; Cerebral Ventricles; Humans; Intracranial Hypertension; Minocycline; Prospective Studies; Rifampin

Topics: Adolescent; Female; Humans; Intracranial Hypertension; Intracranial Pressure; Minocycline; Optic Atrophy; Papilledema; Pseudotumor Cerebri; Vision Disorders

Topics: Adult; Anti-Bacterial Agents; Contraceptive Agents, Hormonal; Female; Humans; Intracranial Hypertension; Intrauterine Devices; Levonorgestrel; Minocycline

To describe the clinical course of an unusually severe case of minocycline-induced intracranial hypertension.. Case study.. Academic medical center.. Twelve-year-old girl with a fulminant course of intracranial hypertension.. Magnetic resonance imaging and venography of the brain, lumbar puncture, and optic nerve sheath fenestration.. Although the patient ceased minocycline treatment, there was ongoing and rapid worsening of symptoms and vision loss. Lumbar puncture, which normally acts as a temporizing measure to preserve vision, failed to prevent, and may even have precipitated, further deterioration in vision, necessitating surgical intervention with optic nerve sheath fenestration.. Minocycline can cause a fulminant syndrome of elevated intracranial pressure, with severe vision loss, even after the medication has been discontinued.

Topics: Child; Female; Humans; Intracranial Hypertension; Minocycline; Optic Nerve; Vision Disorders

Topics: Acne Vulgaris; Adult; Female; Humans; Intracranial Hypertension; Minocycline

We report two cases of bilateral papilledema in young women. The first patient was 15 years old and had experienced headaches and vomiting for one month, but no visual loss. Cerebral tomodensitometry results were normal, but lumbar puncture showed increased pressure and normal biology. Benign intracranial hypertension was diagnosed. Recent treatment with minocycline for acne vulgaris was the only etiology. Papilledema was totally regressed at 6 weeks, after interruption of the antibiotic treatment. A prescription of acetazolamide was added for a short period of 10 days. The second patient, aged 29 years, presented bilateral papilledema with severe visual loss, with vision limited to light perception with mydriasis of the right eye. Lumbar puncture was not indicated because of a hypophyseal microadenoma revealed on MRI investigation. No other associated abnormalities were observed, in particular, no cerebral sinus thrombosis. Corticotherapy using prednisolone for 72 hours had no clinical effect. Fast visual recovery was obtained with intravenous acetazolamide therapy and was completely resolved at 2 months. Right visual field defects persisted. Minocycline and obesity are recognized as precipitating factors in pseudotumor cerebri syndrome. The literature advocates consideration of surgical treatment by optic nerve sheath fenestration if antiedematous treatment has no effect and the eye is nearly blind.

Topics: Acetazolamide; Adolescent; Adult; Anti-Bacterial Agents; Carbonic Anhydrase Inhibitors; Female; Fluorescein Angiography; Follow-Up Studies; Humans; Injections, Intravenous; Intracranial Hypertension; Minocycline; Obesity; Papilledema; Pseudotumor Cerebri; Time Factors; Visual Acuity

Topics: Adolescent; Anti-Bacterial Agents; Female; Humans; Intracranial Hypertension; Minocycline