Pseudotumor
Understanding Pseudotumor
Pseudotumor cerebri, also known as idiopathic intracranial hypertension, manifests when there is an unexplained elevation in the pressure within the skull, known as intracranial pressure. Its symptoms closely resemble those of a brain tumor, with the heightened intracranial pressure potentially leading to optic nerve swelling and subsequent vision impairment. While medications are frequently effective in alleviating this pressure and associated headaches, certain situations may necessitate surgical intervention.
Pseudotumor cerebri can affect individuals of various age groups, including children and adults. However, it is most prevalent among women of childbearing age, particularly those who are obese.
Symptoms
- Frequently intense headaches, potentially originating behind the eyes.
- Auditory sensations of a pulsating, whooshing sound within the head, synchronized with the heartbeat.
- Experiencing nausea, vomiting, or bouts of dizziness.
- Vision impairment, which may include partial or complete loss of vision.
- Transient episodes of blindness, typically lasting a few seconds and affecting one or both eyes.
- Challenges with peripheral vision.
- Double vision (diplopia).
- Perceiving flashes of light.
- Discomfort in the neck, shoulders, or back.
Diagnosis
To diagnose your condition, your healthcare provider will follow a comprehensive approach, which includes:
1. Symptoms and Medical History Review:
Your doctor will thoroughly discuss your symptoms and gather information about your medical history to assess the nature and progression of your condition.
2. Physical Examination:
A detailed physical examination will be conducted, including an assessment of your eyes, to check for specific signs of pseudotumor cerebri. An ophthalmologist may examine the optic nerve and assess for any noticeable swelling at the back of your eyes.
3. Vision Testing:
You will undergo eye exams to evaluate your visual function. This may involve a visual field test to detect any blind spots beyond the typical blind spots in each eye, where the optic nerve connects to the retina. Additionally, images of your eyes may be taken, and an optical coherence tomography (OCT) scan may be performed to measure the thickness of retinal layers.
4. Neuroimaging:
Your doctor may order neuroimaging tests, such as Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) scans. These imaging studies help exclude other potential causes of your symptoms, including brain tumors or blood clots.
5. Lumbar Puncture (Spinal Tap):
In some cases, a lumbar puncture may be recommended to measure the pressure inside your skull and analyze the cerebrospinal fluid. During this procedure, a specialist inserts a needle into the lower back to obtain a small sample of cerebrospinal fluid for laboratory testing.
These diagnostic measures collectively aid in confirming or ruling out pseudotumor cerebri and contribute to developing an appropriate treatment plan.
Treatment
The primary objective of pseudotumor cerebri treatment is to alleviate symptoms and prevent further deterioration of vision.
For individuals who are overweight or obese, weight management is often recommended as an initial step. This may involve adopting a low-sodium diet to aid in symptom improvement. Collaborating with a dietitian can be beneficial in achieving weight loss goals. In some cases, weight reduction programs or surgical interventions, such as gastric surgery, may be considered.
Medications:
1. Glaucoma Drugs: Acetazolamide, a glaucoma medication, is frequently prescribed as an initial treatment. It aims to reduce the production of cerebrospinal fluid, thus alleviating symptoms. Possible side effects may include stomach discomfort, fatigue, tingling sensations in extremities, and the formation of kidney stones.
2. Other Diuretics: If acetazolamide alone proves insufficient, it may be combined with another diuretic to enhance fluid elimination and reduce fluid retention.
3. Migraine Medications: Some individuals may benefit from migraine medications to manage the severe headaches often associated with pseudotumor cerebri.
Surgical Interventions:
1. Optic Nerve Sheath Fenestration: This surgical procedure involves creating a small window in the membrane surrounding the optic nerve to allow excess cerebrospinal fluid to escape. Vision stabilization or improvement is observed in most cases. While benefits may extend to both eyes even if performed on one eye, success rates can vary, and vision complications may increase.
2. Spinal Fluid Shunt: In this surgery, a thin tube (shunt) is inserted into the brain or lower spine to facilitate the drainage of excess cerebrospinal fluid. The shunt is tunneled under the skin to the abdomen, where it releases the accumulated fluid. Shunt placement is typically considered if other treatments prove ineffective. However, shunts may require maintenance surgeries due to potential blockages and can lead to complications like low-pressure headaches and infections.
3. Venous Sinus Stenting: This procedure, although rarely employed, involves the placement of a stent in a major head vein to enhance blood flow. Further research is necessary to determine the full benefits and risks of this method.
After experiencing pseudotumor cerebri, ongoing regular vision assessments are essential to monitor any changes in visual function and ensure timely intervention when needed.
Contact Us For An Appointment
The care team at North Carolina Neuroscience & Spine Center can help you decide on the treatment that's best for you. They specialize in minimally invasive surgery and are experienced in diagnosing and treating disorders and diseases, using the newest techniques for relieving pain and returning you to an active lifestyle. To make an appointment at North Carolina Neuroscience & Spine Center call 919-784-7550.
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