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[服用米诺环素所致的假性脑瘤]

[Pseudotumor cerebri due to taking minocycline].

作者信息

Kaabour M, Guerisse F, Mols P, Levy S

机构信息

Service des Urgences Pédiatriques, H.U.D.E.R.F.

Service de Médecine Interne-Urgences, C.H.U. Tivoli, La Louvière.

出版信息

Rev Med Brux. 2017;38(3):169-172.

Abstract

The cerebral pseudotumor (PTC) is defined by the increase in cerebrospinal fluid (CSF) pressure, a normal composition of the latter in the absence of identified intracranial structural abnormalities, in particular by neuroimaging. The pathophysiology of PTC is poorly understood although its diagnostic criteria are well established. Drugs such as minocycline, tetracycline and doxycycline have been repeatedly implicated as a causative factor in PTC. The prognosis of PTC related to minocycline, reported in the literature is quite variable. Some authors suggest a benign condition with spontaneous healing by stopping the antibiotic, while others report permanent loss of vision. A 12-year-old girl is admitted to the emergency room for progressively progressive pulsatile temporal headaches associated with diplopia. The patient reported the use of minocycline 50 mg / d for five months, prescribed by her attending physician as part of an acne treatment. PTC will be demonstrated by severe papillary edema and cerebral NMR will demonstrate an enlargement of the subarachnoid space around the optic nerves. After three lumbar punctures, the condition of the patient stabilized and there was a marked improvement in headache despite the persistence of bilateral papillary edema. This work describes a clinical case of PTC induced by the use of minocycline and reviews the physiopathology, the diagnosis and the management of this one.

摘要

脑假瘤(PTC)的定义是脑脊液(CSF)压力升高,在未发现颅内结构异常(特别是通过神经影像学检查)的情况下,脑脊液成分正常。尽管PTC的诊断标准已明确,但对其病理生理学的了解仍很有限。米诺环素、四环素和多西环素等药物多次被认为是PTC的致病因素。文献报道的与米诺环素相关的PTC预后差异很大。一些作者认为这是一种良性疾病,停用抗生素后可自愈,而另一些作者则报告有永久性视力丧失。一名12岁女孩因进行性搏动性颞部头痛伴复视入住急诊室。患者报告在其主治医生的处方下,服用了50毫克/天的米诺环素五个月,作为痤疮治疗的一部分。PTC将通过严重的视乳头水肿得到证实,脑部核磁共振成像将显示视神经周围蛛网膜下腔增宽。经过三次腰椎穿刺后,患者病情稳定,尽管双侧视乳头水肿仍然存在,但头痛有明显改善。本文描述了一例因使用米诺环素引起的PTC临床病例,并对其病理生理学、诊断和治疗进行了综述。

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