Fulminant Pseudotumor Cerebri Syndrome Secondary to Over-the-Counter Topical Retinoids

Pseudotumor cerebri syndrome (PTCS) is a constellation of symptoms and signs related to increased intracranial pressure. Although most cases present with gradual development of symptoms, fulminant presentations occur, with occurrence of visual loss within 1 month of headache onset(1). Excessive oral intake of vitamin A is considered an important risk factor for the development of PTCS.Increased cerebrospinal fluid (CSF) outflow resistance, vita-min A metabolism dysregulation, venous sinus thrombosis,or venous hypertension have been suggested as possible pathogenic mechanisms (2). Topical retinoids are used in the treatment for a number of skin conditions such as psoriasis,warts, and facial acne. PTCS has only been associated with topical retinoids twice before (3,4), but this is the first report of a fulminant presentation after topical exposure.