Ultrasound monitoring for minocyclineinduced idiopathic intracranial hypertension

We report a rare case of idiopathic intracranial hypertension following oral minocycline therapy for the treatment of acne. A 29-year-old, non-obese female, with a history of minocycline use for 1 month for treatment of acne presented with headache and transient blurred vision for 3 weeks. She was found to have bilateral disc edema with normal visual acuity and color vision. Magnetic resonance imaging of the brain was normal with partially empty sella features and enlarged tortuous optic nerve in both eyes. Cerebrospinal fluid opening pressure was high. Ultrasound B-scan was done to serially monitor the optic nerve sheath diameter. She improved significantly after stopping the minocycline and following intracranial pressure lowering measures. Idiosyncratic reaction of intracranial hypertension with minocycline can be symptomatic as early as 1 week. Consultants should be aware of this as early consult with ophthalmologists/neurologists can prevent visual loss. A simple ultrasound B-scan can prove to be a vital non-invasive tool in monitoring these patients.