Pseudotumor Cerebri Opening Pressure

Pseudotumor Cerebri Diagnosis

• • In pseudotumor cerebri opening pressure may be normal on lumbar puncture. Establishing a diagnosis in this situation can be difficult.
  • Pseudotumor cerebri occurs when there is an increase in the intracranial pressure for reasons that are not entirely clear.
  • The fact that no definite cause can be found for the raised ICP and that there is no tumor responsible for the symptoms, lead to pseudotumor cerebri also being referred to as idiopathic intracranial hypertension and benign intracranial hypertension.
  • These three terms are synonymous though IIH i.e Idiopathic Intracranial Hypertension is the term used commonly.
  • The disorder is 10 times more common in women. Obese women of childbearing age are particularly at risk.
  • Other associations include oral contraceptive use, vitamin A toxicity and tetracycline antibiotics. Chronic pulmonary diseases and Addison’s disease also have an association with IIH.
  • The common clinical presentation includes headache, diplopia/ double vision and/or a 6th nerve palsy.
  • The imaging investigations including CT and MRI are normal.
  • The blind spot is enlarged on visual field testing and the raised ICP can cause papilledema leading to possible blindness due to progressive optic atrophy.
  • The condition can linger on for several months and may resolve spontaneously afterwards.
  • In pseudotumor cerebri opening pressure is usually high.
  • Besides this increase in pressure the CSF (Cerebrospinal Fluid) studies are normal.

    Pseudotumor Cerebri Treatment

• The lumbar puncture is done only after ruling out the possibility of a space occupying lesion in the cranial cavity.
• The goal of management is to preserve the vision along with addressing the raised ICP and its symptoms.
•  Treatment options include diuretics like furosemide (loop diuretic) and acetazolamide (a carbonic anhydrase inhibitor), both lower the intracranial pressure (ICP) via reducing cerebrospinal fluid (CSF) production through the choroid plexus.
• Steroids like prednisolone and repeated therapeutic lumbar punctures are also utilized in lowering the ICP.  Surgical shunt between the ventricles and peritoneum can be placed as a last resort for definite treatment.