What Is Pseudotumor Cerebri?
Pseudotumor cerebri refers to a condition of increased intracranial pressure, or pressure inside the skull. It is also known as idiopathic intracranial hypertension. The symptoms mimic those of a brain tumor, but a pseudotumor cerebri diagnosis is made only in the absence of a brain mass or tumor. The exact causes of the condition are unknown, but multiple clues are present in most cases. Among the most common are:
- The use of certain drugs, such as nalidixic acid, tetracycline, nitrofurantoin, lithium and amiodarone
- The overuse of vitamin A
- Being overweight or having a rapid weight gain
This condition can occur in adults and children, but the most common patients are women of childbearing years who are overweight or obese.
Pseudotumor Cerebri Symptoms
The main symptom of pseudotumor cerebri is a certain type of headache. It begins behind the eyes and can worsen with every head movement. A pseudotumor cerebri headache can also involve the entire head. You may also experience some other symptoms along with your headache, such as:
- Dizziness, vertigo or vomiting
- A ringing in the ears that pulses with the heart, known as pulsatile tinnitus
- Blurry or dimmed vision
- Temporary blindness in one or both eyes
- Double vision or troubles with peripheral vision
- Seeing bright flashes of light
- Pain that can radiate down the neck toward the back and shoulders
The diagnosis for pseudotumor cerebri is made after careful review of the symptoms and the patient’s medical history. The diagnostics that the headache specialist will use include a complete physical examination and other tests such as a brain MRI or CT scan to rule out blood clots or tumors. The doctor may also perform a spinal tap to measure the pressure of the spinal fluid, which can provide information about intracranial pressure as well as protein and glucose levels.
Other common tests include an eye examination to look for swelling in the optic nerve and a visual field test to check for loss of peripheral vision or blind spots.
Pseudotumor Cerebri Treatment
It’s important that treatment begin as soon as a diagnosis is reached. Delay of treatment can lead to eyesight damage or a permanent loss of vision. The goal of treatment for this condition is to prevent the eyesight from worsening and to treat any painful symptoms. Surgery is common to relieve the pressure around the optic nerve, to relieve intracranial pressure or to prevent a degeneration in the eyesight.
Pseudotumor cerebri medication is usually based on each patient’s individual symptoms. They can include medications that work to reduce the production of cerebrospinal fluid and steroids to reduce brain tissue swelling. Hyperosmotic drugs such as diuretics are often useful in reducing the amount of fluid built up in the body.
Since the main symptom of all patients with this condition is moderate to severe headaches, the medications used to relieve migraines are often prescribed for them. While not universally effective, these medications can reduce the amount of discomfort many patients are feeling.
If the patient’s symptoms are found to be due to weight gain or obesity, weight loss will always be included in the treatment plan. Dietary changes are key, and physical or recreational therapy can help keep patients on course.
Optic nerve fenestration and spinal fluid shunts can be used if all other measures have no positive results. These procedures can have serious complications, however, and are only used if nothing else gives a patient relief from pseudotumor cerebri symptoms. Spinal fluid shunt surgery is more common than fenestration, but both are extremely rare.