Pseudotumor Cerebri

Pseudotumor Cerebri, also called benign intracranial hypertension or idiopathic intracranial hypertension, is a condition in which the pressure inside the skull increases without any obvious reason. Most commonly, it affects obese women of childbearing age.

Most of the symptoms are related to:

1. Increased intracranial pressure.

2. Papilledema: a swelling around the optic disc (the site of entry of the optic nerve to the eyeball). It occurs due to increase in the intracranial pressure.

Symptoms of pseudotumor cerebri include:

* Symptoms due to increased intracranial pressure:

1. Headache, ranging from moderate to severe, that originates deep to the eye and that worsen with eye movements.

2. Pulsatile tinnitus: ringing sound in the ears which are synchronous with the pulse.

3. Double vision.

4. Nausea and vomiting.

* Symptoms due to papilledema:

1. Dimming or black-out of vision in either eyes or both that lasts for seconds (visual obscurations).

2. Blurring of vision.

3. Having a difficulty to look to the sides.

How is pseudotumor cerebri diagnosed?
– Fundus examination: a doctor will examine the patient's eye to confirm the presence of papilledema.

– Imaging studies as CT scan and MRI to visualize any other pathology causing similar symptoms.

– A lumbar puncture can be done to measure the intracranial pressure.

What is the treatment of Pseudotumor Cerebri?
Untreated cases can be complicated by secondary optical atrophy and permanent blindness.

Medical treatment options:
It aims for decreasing the intracranial pressure. Acetazolamide (Diamox) is used in cases without visual loss. Corticosteroids (prednisone) can be used if there are severe symptoms or visual loss. Obese women must reduce their weight.

If medical treatment is not successful in controlling the symptoms or there is progressive visual loss, surgery is done.

Surgical options:
Either i.) CSF shunting procedure: using a lumboperitoneal shunt is commonly used. It will allow excess CSF to pass directly into the peritoneum. So the intracranial pressure is maintained at a normal level. Disadvantages of the use of a shunt include infections and low pressure headaches.

Or ii.) Optic nerve sheath fenestration:

The aim of this surgery is to relieve the pressure from around the optic nerve and so preserves vision. This will allow CSF to pass to the orbital fat and then to the venous circulation where it will be absorbed.

Should the patient change his / her diet?
Yes. It is a must that all patients should be put on a weight-reduction diet. Beside, exercising is important in helping reducing one's weight.