Primary pseudotumor cerebri syndrome without headache: a report of 3 cases and review of the literature

Abstract

Background: Pseudotumor cerebri syndrome (PTCS) encompasses a variable combination of signs and symptoms of raised intracranial pressure without a brain tumor or space occupying lesion. The lack of continuous pancephalic/retro-orbital headache or pulsating tinnitus is a well-documented observation. Cases' presentation: We report on 3 non-obese women who presented with progressive visual loss. All of them stated that their headache was mild, nonsignificant, intermittent, or migraine-like which did resolve spontaneously or after the use of oral paracetamol. Nausea and/or vomiting were present. Variable degrees of reduction in the visual acuity, enlargement of the physiological blond spot, peripheral visual field constriction, papilloedema, and secondary optic atrophy were found. Their CSF opening pressure was 42, 37, and 39 cm H2O respectively; other CSF parameters were normal. Their diagnosis was primary PTCS. Conclusion: PTCS remains a diagnostic challenge. The lack of significant headache (and obesity) contributed to the delayed diagnosis with resultant visual loss.