Pseudotumor Cerebri



Also referred to as:

Increased Intracranial Pressure







The edges of this swollen optic nerve (the yellow disc in the center) have become blurred and indistinct



Pseudotumor cerebri is a condition of increased intracranial pressure (high pressure inside the cranial cavity) which most commonly affects 20 to 45 year old overweight women. Patients usually present with episodes of "graying out of vision", known as transient visual obscurations. These episodes of vision loss usually last just a few seconds. Some patients will notice a blind spot in their peripheral vision and others may have double vision. Headaches are very common.



Although in the great majority of cases, the cause is unknown, some cases are associated with corticosteroid treatment (e.g., prednisone), vitamin A over-dosage, tetracyclines, nalidixic acid, and radical neck surgery (e.g., for cancer). The diagnosis is made after discovering papilledema (swollen optic nerves) and a MRI or CT scan of the brain rules-out other conditions which might cause increased intracranial pressure (e.g., tumor). The diagnosis is confirmed by a lumbar puncture (spinal tap) which demonstrates increased cerebrospinal fluid (CSF) pressure, but the CSF is otherwise normal in laboratory analyses.



If the condition is untreated, vision may progressively worsen due to chronic papilledema (swollen optic nerves) with consequent atrophy of the optic nerves. Most patients are initially treated with diuretics (e.g., Diamox) to reduce intracranial pressure, perhaps with the use of corticosteroids and repeated lumbar punctures to drain off CSF. Most patients must be encouraged to lose weight. Surgery is recommended for those that have progressive peripheral vision loss or intractable headaches, despite medical therapy. Surgery usually consists of optic nerve sheath fenestration if the primary symptoms are visual or a lumbo-peritoneal (L-P) shunt if the symptoms are primarily headache related. Either procedure may be effective at controlling the signs and symptoms of the disorder, by decreasing intracranial pressure.



From EyeMDLink.Com