Pseudotumor cerebri (idiopathic intracranial hypertension)

Description

Pseudotumor cerebri (SOO-doe-too-mur SER-uh-bry) occurs when the pressure within the skull (intracranial pressure) increases for no obvious reason. It is also called idiopathic intracranial hypertension.

The symptoms are similar to those of a brain tumor. The increased intracranial pressure can cause swelling of the optic nerve and result in vision loss. Medications often can reduce the pressure and headache, but in some cases, surgery is necessary.

Pseudotumor cerebri can occur in children and adults, but it is more common in women of childbearing age who are obese.

Symptoms

Pseudotumor cerebri signs and symptoms may include:

  • Often severe headaches that could come from behind your eyes
  • A whooshing sound in your head that pulses with the beat of your heart
  • Nausea, vomiting, or dizziness
  • The loss of vision
  • Brief episodes of blindness, that lasts for a few seconds and affects one or both eyes
  • Difficult to see next
  • Double vision
  • Seeing flashes of light
  • The neck, shoulder, or back pain

Sometimes, the symptoms have resolved may recur months or years later.

Causes

The cause of pseudotumor cerebri is unknown. If a cause is determined, the condition is called secondary intracranial hypertension, in place of "idiopathic".

The brain and spinal cord are surrounded by cerebrospinal fluid, these cushions vital tissues of the injury. This fluid is produced in the brain and, finally, be absorbed into the bloodstream at a rate that usually allows the pressure in his brain to remain constant.

The increased intracranial pressure in pseudotumor cerebri could be the result of a problem in this process of absorption.

Risk factors

The following factors have been associated with pseudotumor cerebri:

Obesity

Obese women of childbearing age are more likely to develop the disorder.

Drugs

The substances connected to the secondary of intracranial hypertension include:

  • Growth hormone
  • Tetracycline
  • Too much vitamin a

Health problems

Conditions and diseases that have been linked to the secondary intracranial hypertension include:

  • Addison's disease
  • Anemia
  • Blood-clotting disorders
  • Kidney disease
  • Lupus
  • Polycystic ovary syndrome
  • Sleep apnea
  • Hypofunction of the parathyroid glands

Complications

For some people with pseudotumor cerebri, his vision continues to get worse, which leads to blindness.

Pseudotumor cerebri (idiopathic intracranial hypertension)

Diagnosis

To diagnose your condition, your doctor will review your medical history and symptoms, perform a physical exam and order tests.

Eye exams

If pseudotumor cerebri is suspected, a doctor trained in the affections of the eyes (eye doctor) will look for a distinctive type of swelling that affects the optic nerve at the back of the eye.

You will also have to submit to a visual field test to see if there are blind spots in the vision, in addition to its normal mode of the call blind spot in each eye where the optic nerve enters the retina. And it is likely you have photos of your eyes and to a diagnostic test to measure the thickness of the layers of the retinal (optical coherence tomography).

Images of the brain

Your doctor may order a Magnetic resonance imaging (MRI) or computerized tomography (CT scan). These tests can rule out other problems that can cause similar symptoms, such as brain tumors and blood clots.

Lumbar puncture (lumbar puncture)

Your doctor may order a lumbar puncture to measure the pressure inside your skull and analysis of the cerebrospinal fluid. In this test, a specialist inserts a needle between two vertebrae in the lower part of your back and removes a small amount of cerebrospinal fluid for analysis in the laboratory.

Treatment

The aim of pseudotumor cerebri treatment is to improve symptoms and maintain your vision from worsening.

If you are obese, your doctor may recommend a low-sodium diet weight loss to help improve your symptoms. You could work with a dietitian to help you with your weight loss goals. Some people benefit from programs of weight loss or gastric surgery.

Drugs

  • Glaucoma drug.One of the first drugs usually tries is to acetazolamide, a glaucoma drug. This drug may also reduce the production of cerebrospinal fluid, and reduce the symptoms. Possible side effects include upset stomach, fatigue, tingling sensation in the fingers, feet, toes, and mouth, and kidney stones.
  • Other diuretics. If acetazolamide alone is not effective, sometimes combined with another diuretic, which reduces fluid retention by increasing urine output.
  • Drugs for migraine. These medications can sometimes relieve the severe headaches that often accompany pseudotumor cerebri.

Glaucoma drug. One of the first drugs usually tries is to acetazolamide, a glaucoma drug. This drug may also reduce the production of cerebrospinal fluid, and reduce the symptoms.

Possible side effects include upset stomach, fatigue, tingling sensation in the fingers, feet, toes, and mouth, and kidney stones.

Surgery

If your vision gets worse, the surgery to reduce the pressure around your optic nerve or the reduction of the intracranial pressure may be necessary.

  • Optics of the fenestration of the nerve sheath.In this procedure, a surgeon cuts a window in the membrane that surrounds the optic nerve to allow the excess cerebrospinal fluid to escape. Vision stabilized or improved in the majority of cases. Most of the people who have performed this procedure in one eye, you notice a benefit for both eyes. However, this surgery is not always successful and can increase the problems of vision.
  • Derivation of the cerebrospinal fluid.In another type of surgery, your doctor inserts a long, thin tube (shunt) in the brain or the lower spine to help drain the excess cerebrospinal fluid. The pipe is buried under the skin of your abdomen, where the derivation releases the excess liquid. A referral is usually considered only if other treatments have not alleviated her condition. The taps can clog and often require further surgery to keep them working. Complications may include low pressure, headaches, and infections.
  • Venous sinus stenting. This relatively new procedure is rarely used. This involves the placement of a stent in one of the larger veins in the head to increase the blood's ability to flow. Further studies are needed to determine the benefits and risks of this procedure.

Optics of the fenestration of the nerve sheath. In this procedure, a surgeon cuts a window in the membrane that surrounds the optic nerve to allow the excess cerebrospinal fluid to escape.

Vision stabilized or improved in the majority of cases. Most of the people who have performed this procedure in one eye, you notice a benefit for both eyes. However, this surgery is not always successful and can increase the problems of vision.

Derivation of the cerebrospinal fluid. In another type of surgery, your doctor inserts a long, thin tube (shunt) in the brain or the lower spine to help drain the excess cerebrospinal fluid. The pipe is buried under the skin of your abdomen, where the derivation releases the excess liquid.

A referral is usually considered only if other treatments have not alleviated her condition. The taps can clog and often require further surgery to keep them working. Complications may include low pressure, headaches, and infections.

Once you have ever had pseudotumor cerebri, you will need to have an eye exam on a regular basis to monitor changes.

Self-care

Obesity dramatically increases young women's risk of pseudotumor cerebri. Even in women who are not obese, a moderate amount of weight gain can increase the risk.

To lose extra pounds and maintain a healthy weight can help reduce your chances of developing this potentially sight-stealing disorder.

Preparing for your appointment

After discussing your symptoms with your family doctor, he or she may refer you to a medical doctor trained in brain and nervous system conditions (neurologist) or a condition of the eye), or both (neuro-ophthalmologist) for further evaluation.

Here's some information to help you prepare for your appointment.

What you can do

Make a list of:

  • Your symptoms, including any that may seem unrelated to the reason for which you scheduled the appointment, and when they began
  • Key personal information, including major stresses or recent life changes
  • All medications, vitamins or supplements that you are taking, including dose
  • Questions to ask your doctor

Bring with you to the appointment of the latest results of the tests and scans his eyes. Have a friend or family member, if possible, to help you remember the information that you receive.

For pseudotumor cerebri, questions to ask your doctor include:

  • What is likely causing my symptoms or condition?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What is the best course of action?
  • Would losing weight help my condition?
  • I have these other health conditions. How can I best manage them together?
  • There are restrictions that must be followed?
  • You should see a specialist?
  • Are there brochures or other printed material I can have? What sites do you recommend?

Do not hesitate to ask other questions.

What to expect from your doctor

Your doctor may ask you questions, including:

  • The symptoms been continuous or occasional?
  • How severe are the symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Symptoms and treatment of Pseudotumor cerebri (idiopathic intracranial hypertension)