Pseudotumor cerebri

Abstract

PTC, a potentially blinding disease, most commonly manifests with headache and slightly blurred vision due to papilledema. This review seeks to present a methodical approach to its diagnosis and treatment.

Pseudotumor Cerebri: Brief Review of Clinical Syndrome and Imaging Findings

“…20,51 In this approach, the surgeon cuts slits in the ONS behind the globe to allow CSF to leak from the subarachnoid space. 22,49 Postoperative MR imaging showing fluid collections adjacent to the site of fenestration supports CSF extravasation into the orbit as the mechanism by which ONSF relieves symptoms. 51 While some studies have alleged that the incidence of serious complications from ONSF is as low as 1%, ONSF may result in worsening vision, infection, oculomotor dysfunction (albeit generally temporary), and death (in 1 older study).…”

“…Some clinicians advocate the use of corticosteroids in patients with severe headache, acute papilledema, and very high CSF pressure. 15,49 Therapeutic lumbar puncture is another common treatment method and addresses the issue of elevated CSF pressure directly by reducing it immediately; 1 older study suggests that the effects are short-lived, with a return to initial pressure within just Ͼ1 an hour. 50 There is little published evidence comparing lumbar puncture with medication or other treatment modalities.…”

“…As a result, shunt placement necessitates frequent neurologic follow-up. 22,49 Many ophthalmologists advocate ONSF (also called decompression) as an alternative surgical approach associated with fewer complications and improved outcomes in the management of refractory PTC. 20,51 In this approach, the surgeon cuts slits in the ONS behind the globe to allow CSF to leak from the subarachnoid space.…”

Neuroimaging - Clinical Applications

“…Short-term oral corticosteroids may be considered as a treatment option in patients presenting with severe headaches, marked papilledema, and very high intracranial pressure. High doses of intravenous corticosteroid treatment may occasionally be administered when there is rapidly progressive vision loss or while the patient awaits surgery (Mathews et al, 2003). Treatment medication is usually given over a long period of time.…”

“…If symptoms reoccur, reinstitution of medications is usually indicated (Friedman & Jacobson, 2004). Weight loss is a crucial part of the treatment program, as even moderately obese patients may significantly benefit from a sensible diet and exercise program (Mathews et al, 2003). Medications known as associated risk factors for pseudotumor syndromes, such as vitamin A, vitamin A derivatives, and tetracycline should be discontinued if possible.…”