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      Pseudotumor cerebri in a child treated with acitretin: A rare occurrence

      case-report

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          Abstract

          Pseudotumor cerebri (PTC) is a rare neurological disorder characterized by increased intracranial pressure in absence of any intra-cranial space-occupying lesion. It is mostly due to impairment of drainage of CSF from arachnoid villi. Clinically pseudotumor cerebri presents with headache, diplopia, nausea, vomiting, papilloedema and if treatment is delayed, may lead to blindness. Females of childbearing age group, endocrinal abnormalities and ingestion of certain drugs have been reported to be associated with pseudotumor cerebri. However, it's occurrence in relation to acitretin ingestion has not been reported on pubmed database. Here we present a case where significant temporal association of acitretin intake with PTC was found in a child who was being treated with this medication for recalcitrant pustular psoriasis. The case is reported for its rarity in occurrence and associated significant morbidity including visual loss if not diagnosed and treated immediately. According to Naranjo ADR Causality scale of adverse drug reaction, the association of PTC due to acitretin in our case was probable.

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          Most cited references12

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          The incidence of pseudotumor cerebri. Population studies in Iowa and Louisiana.

          We surveyed all neurologists, ophthalmologists, and neurosurgeons in Iowa, eastern Nebraska, and Louisiana over one year to determine the annual incidence of pseudotumor cerebri in residents of Iowa and Louisiana. The results were similar for both states. In Iowa, the annual incidence in the general population was 0.9 per 100,000 persons. When obesity was considered, this increased the incidence to 13/100,000 persons in Iowa and 14.85/100,000 persons in Louisiana for women 20 to 44 years of age who were 10% or more over ideal weight. Furthermore, the incidence became 19.3/100,000 for women in the same age range when they were 20% or more over ideal weight. The female-to-male ratio was 8:1, and the mean weight was 38% above ideal weight for height. Pseudotumor cerebri is a relatively common neurologic illness and may be an important preventable cause of blindness in obese young women.
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            British Association of Dermatologists guidelines on the efficacy and use of acitretin in dermatology.

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              Risk factors for idiopathic intracranial hypertension in men: a case-control study.

              To identify risk factors for idiopathic intracranial hypertension (IIH) in men. Case-control study. A 96-item telephone questionnaire, answered retrospectively, with cases recalling at the age of their diagnosis and controls recalling at the age of their corresponding case's diagnosis. Outpatient clinics in two US tertiary care centers. The characteristics of 24 men with IIH were compared to those of 48 controls matched for sex, age, race, and World Health Organization body mass index (BMI) category. Two previously validated questionnaires: the ADAM (Androgen Deficiency in Aging Males) questionnaire for testosterone deficiency and the Berlin questionnaire for obstructive sleep apnea (OSA), embedded within the telephone questionnaire. Analysis with Mantel-Haenszel odds ratios and mixed-effects logistic regression models accounted for matching. Cases and controls had similar enrollment matching characteristics. Although matching was successful by BMI category, there was a small difference between BMI values of cases and controls (cases: median 31.7, controls: median 29.9; p=0.03). After adjustment by BMI value, men with IIH were significantly more likely than controls to have a positive ADAM questionnaire for testosterone deficiency (OR: 17.4, 95% CI: 5.6-54.5; p<0.001) and significantly more likely to have either a positive Berlin questionnaire for OSA or history of diagnosed OSA (OR: 4.4, 95% CI: 1.5-12.9; p=0.03). Men with IIH are more likely than controls to have symptoms associated with testosterone deficiency and OSA. These associations suggest a possible role for sex hormones and OSA in the pathogenesis of IIH in men.
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                Author and article information

                Journal
                Indian J Pharmacol
                Indian J Pharmacol
                IJPharm
                Indian Journal of Pharmacology
                Medknow Publications & Media Pvt Ltd (India )
                0253-7613
                1998-3751
                Jan-Feb 2013
                : 45
                : 1
                : 89-90
                Affiliations
                [1]Department of Dermatology, School of Tropical Medicine, Kolkata, West Bengal, India
                Author notes
                Correspondence to: Dr. Kapildev Das, E-mail: arunkd1212@ 123456gmail.com
                Article
                IJPharm-45-89
                10.4103/0253-7613.106444
                3608304
                23543097
                62908191-c337-431c-a150-01458c952b87
                Copyright: © Indian Journal of Pharmacology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 08 June 2012
                : 27 September 2012
                : 29 October 2012
                Categories
                Case Report

                Pharmacology & Pharmaceutical medicine
                acitretin,child,pseudotumor cerebri
                Pharmacology & Pharmaceutical medicine
                acitretin, child, pseudotumor cerebri

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