Doxycycline-Induced Intracranial Hypertension Presenting as Unilateral Pulsatile Tinnitus

Area of Science:

• Neurology
• Ophthalmology
• Pharmacology

Background:

• Pulsatile tinnitus (PT) is a recognized symptom of idiopathic intracranial hypertension (IIH).
• Secondary causes of intracranial hypertension presenting with PT require clinical awareness.
• Tetracycline-induced intracranial hypertension is a potential, though less common, etiology.

Purpose of the Study:

• To report two cases of isolated pulsatile tinnitus as the sole presenting symptom of intracranial hypertension.
• To highlight the potential role of tetracycline medications in causing intracranial hypertension.
• To emphasize the importance of medication review in diagnosing intracranial hypertension.

Main Methods:

• Case series presentation of two patients with isolated pulsatile tinnitus.
• Review of patient history, medication use (tetracyclines), and clinical findings.
• Assessment of symptom resolution following discontinuation of suspected causative medication.

Main Results:

• Two patients presented with isolated pulsatile tinnitus without headache, visual changes, or papilledema.
• Both patients had a history of tetracycline use (minocycline and doxycycline).
• Pulsatile tinnitus resolved in both patients after discontinuing doxycycline, suggesting tetracycline-induced intracranial hypertension.

Conclusions:

• Isolated pulsatile tinnitus can be the primary manifestation of intracranial hypertension.
• Tetracycline-induced intracranial hypertension should be considered, even with atypical presentations.
• Thorough medication history is crucial for diagnosing and managing intracranial hypertension.