Pseudotumor cerebri and ciprofloxacin: a case report

Rajeev R Fernando,Niraj N Mehta,Morgan G Fairweather

doi:10.1186/1752-1947-5-104

Abstract

IntroductionWe present a case of ciprofloxacin-associated pseudotumor cerebri in a 22-year-old African American woman. Withdrawal of ciprofloxacin in our patient resulted in complete resolution of ciprofloxacin-associated pseudotumor, as evidenced by a normal neuro-ophthalmic examination and a cerebrospinal fluid opening pressure of 140 mmH20.Case presentationA 22-year-old African American woman presented with a headache of two weeks duration, visual blurring and horizontal diplopia after starting ciprofloxacin for pyelonephritis. An ophthalmic examination revealed that she had left eye esotropia, and a picture of the fundus demonstrated bilateral disc swelling without spontaneous venous pulsations. Magnetic resonance imaging of the brain and a magnetic resonance venogram were normal. A diagnostic lumbar puncture demonstrated an elevated opening pressure of 380mmH2O in a supine position. Laboratory examinations, including a cerebrospinal fluid exam, were unremarkable.Conclusionciprofloxacin-associated pseudotumor can cause chronic disabling headache and visual complications. Therapy is sub-optimal, often symptomatic, insufficient and complicated by side effects. When ciprofloxacin-associated pseudotumor presents in an atypical population, an inciting agent must be suspected because prompt withdrawal of the agent may lead to complete resolution of symptoms and prevent recurrence of similar episodes.

Highlights

We present a case of ciprofloxacin-associated pseudotumor cerebri in a 22-year-old African American woman
The treatment of Pseudotumor cerebri (PTC) instead focuses on normalization of intracranial pressure (ICP), either medically or surgically
The improvement of symptoms and subsequent reduction in cerebrospinal fluid (CSF) opening pressure was consistent with the elimination half-life of the drug

Summary

Introduction

Pseudotumor cerebri (PTC) is a condition of increased intracranial pressure (ICP) without clinical, laboratory or radiological evidence of intracranial pathology. The treatment of PTC instead focuses on normalization of ICP, either medically or surgically. The fundus picture demonstrated bilateral disc swelling without spontaneous venous pulsations [Figure 1] Both of her tympanic membranes were intact, and there was no evidence of bulging or discharge. A diagnostic lumbar puncture performed in the recumbent position demonstrated an opening pressure of 380 mmH2O Her cerebrospinal fluid (CSF) protein, glucose, cell count, veneral disease research laboratory test (VDRL), herpes simplex virus 1 and 2, Toxoplasma, cryptococcal antigen, Gram stain, acid fast bacilli stain, routine bacterial, viral, and fungal cultures, and cytology were all normal. The improvement of symptoms and subsequent reduction in CSF opening pressure was consistent with the elimination half-life of the drug She was discharged home with close ophthalmology follow-up. There was complete resolution of papilledema [Figure 2]

Discussion

Conclusion