Medications used to treat pseudotumor cerebri include corticosteroids and glaucoma drugs like acetazolamide. Acetazolamide decreases the amount of cerebrospinal fluid. A diuretic like furosemide is used to decrease the amount of fluid retained by the body. For headaches, migraine medication may be effective.
Yes, you should talk to your doctor about your pseudotumor cerebri symptoms. The condition, if unmonitored, can lead to complete vision loss. Thus, it is important that you seek medical advice if you experience any symptoms.
Diagnosis of pseudotumor cerebri may involve several steps. First, a physical exam is done. This may include checking the eyes for swelling and the head for increased. To measure the intracranial pressure, a lumbar puncture is performed. An MRI or CT scan is performed in order to view the brain and eliminate other causes.
Risk for pseudotumor cerebri may be increased by the use of some medications like lithium, steroids, birth control, or tetracycline among others. Some conditions like Cushing's disease, obesity, pregnancy and hypothyroidism may also play a role in causing pseudotumor cerebri. Women are at higher risk for this condition than men.
Pseudotumor cerebri affects the body by increasing the intracranial pressure. The cause is not known, but experts think this might happen as a result of too much cerebrospinal fluid around the brain. Too much pressure may then be put on the optic nerve and cause swelling. The swelling could lead to vision impairment and eventually blindness. Some other ways in which the pressure might affect the body include headaches, vision problems, feeling dizzy or nauseous, and ringing in the ears.
Increased intracranial pressure is the main symptom of pseudotumor cerebri. Other symptoms include vision problems, headaches, and ringing in the ears. Nausea and vomiting can also be signs of pseudotumor cerebri. The symptoms occur in the absence of obvious causes like infection, tumor, or blood clots.
The exact cause of pseudotumor cerebri is often unknown. It is suspected that the condition is a result of an increased amount of cerebrospinal fluid in the skull which results in increased intracranial pressure. Some medications such as birth control pills, lithium, and tetracycline can be risk factors. Cushing's disease, pregnancy, and obesity are also linked with pseudotumor cerebri.
Idiopathic intracranial hypertension is the name given to a condition characterized by severe headaches and swelling of the optic nerve caused by increased pressure in the fluid surrounding the brain. It is sometimes called pseudotumor cerebri (PTC) syndrome.
Frequently, the patient will initially be evaluated for a brain tumor because the symptoms of IIH are so closely related to those of a brain tumor. However, it should quickly become apparent from imaging scans like MRI or CT, that a brain tumor is not the issue.
Patients with IIH or PTC may present with any of the following symptoms:
- Chronic, severe headaches
- Ringing in the ears
- Blurred vision
- Tunnel vision
- Loss of vision
- Double vision
- Papilledema (swelling of the optic disc)
The most important part of treating idiopathic intracranial hypertension is to try and reduce the level of pressure in the fluid around the brain. The good news is that studies have shown that losing even 10 percent of your body weight can resolve the condition entirely. That is why weight loss is among the first recommendation that doctors will make to treat this problem. Unfortunately, some patients may also need to combine their weight loss program with a medication that specifically lowers the level of pressure in the fluid around the brain.
However, this might not work for all patients or even be a long-term solution. Surgery may be necessary. During this surgical procedure, one of three types of shunts may be used to alleviate the pressure.
Most patients with IIH are good candidates for two types of shunts:
- Ventricular shunt - the fluid will be drained from the brain into the peritoneal cavity or belly or into a chamber in the heart
- Lumbar shunts - the fluid will be drained from the spinal region into the peritoneal cavity or belly
The goal of the shunt is to remove the correct amount of CSF so the patient has relief from all IIH symptoms. The most critical part of the treatment for IIH is to insure that the shunt relieves the pressure in the brain so that the eyes are protected. Your doctor may recommend a procedure called anoptic nerve sheath fenestration. The goal of this procedure is to relieve the pressure on the nerve by making an opening in the covering of the nerve so that the CSF can escape.
An evaluation for IIH will include the following:
- A clinical exam
- Imaging studies.Standard imaging studies are usually normal in IIH, however, the doctor may recommend this test to rule out other possible neurological conditions.
- Examination of your visual fieldsby a highly trained neuro-ophthalmologist.
- These exams will include:
- Assessing your peripheral vision
- Determining if you can distinguish different colors
- Using an eye chart to test your central vision acuity (sharpness)
- Dilation of the pupils (to examine the optic discs for swelling)
- Performance of a spinal tap. This spinal tap will confirm the diagnosis by demonstrating a high pressure of cerebrospinal fluid (CSF)
- Medications (Diamox)
- Weight loss
- Stenting of narrowed cerebral venous sinuses
- Placement of a permanent shunt in order to maintain the normal CSF pressure
- Making an opening in the covering of the optic nerve to let the fluid out and relieve pressure on the nerve.
If the neurologist or neuro-ophthalmologist confirms that you have IIH, he or she will recommend a very aggressive and urgent evaluation and treatment plan. If IIH is not treated immediately, permanent and lasting damage can occur to a patient's vision.