Pseudotumor cerebri lithium

Pseudotumor cerebri (benign intracranial hypertension) has been linked to lithium in over 30 cases, with headache, papilledema, increased intracranial pressure, reduced vision, and a risk of blindness (201). The condition tends to improve on withdrawal, but surgical intervention may sometimes be necessary. A review of pseudotumor cerebri devoted one paragraph to induction of this condition by lithium and provided six references but no new information (202). 

A 17-year-old woman developed pseudotumor cerebri with headache after she had taken lithium for 6.5 weeks (203). Papilledema and increased intracranial pressure resolved fully when lithium was withdrawn, and she was given acetazolamide. 

Other effects on the visual system attributed to lithium include reduced accommodation, exophthalmos, extraocular muscle abnormalities, nystagmus (most characteristically downbeat), oscillopsia, photophobia, and papilledema with visual impairment (pseudotumor cerebri) (201). 

The co-administration of lithium and minocycline in an adolescent was associated with pseudotumor cerebri (659), although minocycline can do this on its own (SED-15, 2349). 

Jonnalagadda J, Saito E, Kafantaris V. Lithium, minocycline, and pseudotumor cerebri. J Am Acad Child Adolesc Psychiatry 2005 44 209. 

A case report describes pseudotumor cerebri in an obese 15-year-old girl taking lithium, 4 months after she started taking minocycline 75 mg twice daily for acne. ... 

These adverse interaction reports are isolated and unexplained. Two reports make the point that these drugs are commonly used for aene eaused by lithium, so any common interaction resulting in raised lithium levels would be expected to have come to light by now. The case of pseudotumor cerebri also appears rare, but note that the female gender and obesity are risk factors for its development and so greater caution may be warranted in this type of patient. The authors advise frequent enquiry about headaches and visual changes. 

Kelly SJ, O Donnell T, Fleming JC, Einhaus S. Pseudotumor cerebri associated with lithium in an 11 year-old boy. J Am Assoc Pediatr Ophthalmol Strabismus 2009 13(2) 204-6. 

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