Pseudotumor Cerebri – Diagnosis and Treatment
Diagnosis
Eye Checkups
Doctors often start by checking the eyes for papilledema, which is swelling of the optic nerves. Swelling of the optic nerves can signal increased intracranial pressure.
An ophthalmologist uses tools to look closely at the back of each eye. Visual field exams help identify vision changes or blind spots. Sometimes, doctors take pictures of the eye and measure the retina layers.
Brain Scans
Doctors use brain imaging to spot other causes of the symptoms. An MRI scan or a CT scan provides detailed images of the brainโs structure.
These scans rule out brain tumors, blood clots, or other issues that might raise intracranial pressure. Sometimes, doctors check the venous sinuses for blockages.
Measuring Fluid Pressure in the Spine
Doctors measure cerebrospinal fluid (CSF) pressure with a spinal tap (lumbar puncture).
For this test, a doctor gently inserts a needle into the lower back and collects a small amount of fluid to check for raised CSF pressure and to make sure the fluid looks normal.
Additional Facts
- Doctors base the diagnosis on symptoms, exam findings, and test results.
- CSF pressure is usually less than 25 cm HโO in adults.
- Doctors may use several tests together to confirm idiopathic intracranial hypertension.
Treatment
Prescription Medicines
Doctors often use certain carbonic anhydrase inhibitors to reduce pressure inside the skull. These medications work by decreasing the production of cerebrospinal fluid, which can help relieve symptoms and protect vision.
In some cases, a neurologically active anticonvulsant may be used to support fluid regulation and help manage associated headaches.
Side effects from these medicines can include:
- Stomach discomfort
- Tired feeling
- Tingling in the fingers or mouth
- Risk of kidney stones
If acetazolamide alone does not control symptoms, doctors may add other diuretics to increase fluid loss through urination and lower pressure further.
Doctors may prescribe migraine medicines to people who often have severe headaches to make daily activities more comfortable.
Doctors avoid using steroids for long-term treatment due to side effects. They may use steroids for short periods in some cases, especially when vision loss is sudden or severe.
Below is a quick summary of medicines:
| Medicine Type | How It Helps |
|---|---|
| Glaucoma drugs | Reduces fluid build-up |
| Diuretics | Helps the body get rid of extra fluid |
| Migraine treatments | Reduces headaches and fluid |
| Steroids | Quick relief in emergencies |
Surgical Options
If medicines do not keep vision from getting worse, surgeons may perform surgery to lower the pressure on the optic nerve or in the brain. A few surgical choices include:
- Optic Nerve Sheath Decompression (also called optic nerve sheath fenestration): A surgeon makes a small hole in the covering of the optic nerve. This lets extra cerebrospinal fluid drain away, which can protect vision and help both eyes, even if only one eye is treated. There are risks, such as possible vision problems afterward.
- Spinal Fluid Shunt: A surgeon places a narrow tube, called a shunt, to carry excess fluid from the brain or spinal area to the belly. Doctors consider this surgery if medicines have not worked. Shunts can sometimes clog or get infected, and extra surgeries may be required.
- Venous Sinus Stenting: In certain cases, a surgeon puts a stent into a large vein in the head to boost blood flow and lower pressure. This method is new and not often used, so more research is needed.
- Gastric Bypass or other weight-loss surgeries may be considered for people whose obesity is linked to high pressure and who have not lost weight with other treatments.
People who undergo any surgery for this condition need regular check-ins to monitor vision and make sure treatments are working.
Taking Care of Yourself
Weight management is an important step for those at risk for pseudotumor cerebri.
Tips for self-care:
- Aim for a healthy weight to help lower the risk.
- Even small weight loss can make a difference.
- Regular activity and a balanced diet may help prevent vision problems linked to this condition.
Getting Ready for Your Visit
Steps You Can Take Before the Visit
Being prepared helps patients make the most of their time with the doctor. The following steps may be helpful:
- Create a list of all symptoms, even those that might not seem related. Note when each symptom started.
- Write down important personal events such as recent stress, life changes, or important health events.
- Gather all medications and supplements, including over-the-counter drugs, vitamins, and herbal products. List doses and how often they are taken.
- Prepare questions to ask, including:
- What might be causing these problems?
- Which tests will be needed?
- Will this condition last a long time?
- What treatments are recommended?
- Would weight loss help?
- How should other health issues be managed together?
- Are there activities to avoid?
- Should a specialist, such as a neurologist, neuro-ophthalmologist, or neurosurgeon, be involved?
- Bring past test results and eye scans if available.
- Consider bringing a support person to help remember information and instructions.
Use this checklist in a table for easy reference:
| What to Bring | Why |
|---|---|
| Symptom list | Track changes |
| Important personal info | Give context |
| Medication list | Avoid risks |
| Prepared questions | Stay informed |
| Test results/scans | Save time |
| Support person (if possible) | Extra help |
Questions Your Doctor Might Ask
To better understand the patientโs condition, the specialist might ask:
- Are the symptoms ongoing or do they come and go?
- How strong or severe are the symptoms?
- Have you noticed anything that improves the symptoms?
- Is there anything that seems to make things worse?
Neurologists, neuro-ophthalmologists, or neurosurgeons might ask these questions during your appointment. Clear answers help the doctor guide the next steps.
