| Category | Neuro Ophthalmology |
Intracranial Hypertension occurs when the pressure inside your skull (intracranial pressure) increases for no obvious reason. It's also called idiopathic intracranial hypertension. Symptoms mimic those of a brain tumor. The increased intracranial pressure can cause swelling of the optic nerve and result in vision loss. Medications often can reduce this pressure and the headache, but in some cases, surgery is necessary. Intracranial Hypertension can occur in children and adults, but it's most common in women of childbearing age who are obese.
Diagnosis
To diagnose your condition, your doctor will review your symptoms and medical history, conduct a physical examination, and order tests.
Eye Exams
If pseudotumor cerebri is suspected, a doctor trained in eye conditions (ophthalmologist) will look for a distinctive type of swelling affecting the optic nerve in the back of your eye.
You'll also undergo a visual field test to see if there are any blind spots in your vision besides your so-called normal blind spot in each eye where the optic nerve enters the retina. And you'll likely have photos taken of your eyes and an imaging test to measure the thickness of the layers of your retina (optical coherence tomography).
Brain Imaging
Your doctor is likely to order an MRI or CT scan. These tests can rule out other problems that can cause similar symptoms, such as brain tumors and blood clots.
Spinal Tap
Your doctor might order a lumbar puncture to measure the pressure inside your skull and analyze your spinal fluid. In this test, a specialist inserts a needle between two vertebrae in your lower back and removes a small amount of cerebrospinal fluid for testing in the laboratory.
Treatment
The goal of pseudotumor cerebri treatment is to improve your symptoms and keep your eyesight from worsening. If you're obese, your doctor might recommend a low-sodium weight-loss diet to help improve your symptoms. You might work with a dietitian to help with your weight-loss goals. Some people benefit from weight-loss programs or gastric surgery.
Medications
Glaucoma drugs. One of the first drugs usually tried is acetazolamide, a glaucoma drug. This medication might reduce the production of cerebrospinal fluid and reduce symptoms. Possible side effects include stomach upset, fatigue, tingling of fingers, toes, and mouth, and kidney stones.
Other diuretics. If acetazolamide alone isn't effective, it's sometimes combined with another diuretic, which reduces fluid retention by increasing urine output.
Migraine medications. These drugs can sometimes ease the severe headaches that often accompany pseudotumor cerebri.
Surgery
If your vision worsens, surgery to reduce the pressure around your optic nerve or to decrease the intracranial pressure might be necessary.
Optic nerve sheath fenestration. In this procedure, a surgeon cuts a window into the membrane that surrounds the optic nerve to allow excess cerebrospinal fluid to escape.
Vision stabilizes or improves in most cases. Most people who have this procedure done on one eye notice a benefit for both eyes. However, this surgery isn't always successful and can increase vision problems.
Spinal fluid shunt. In another type of surgery, your doctor inserts a long, thin tube (shunt) into your brain or lower spine to help drain excess cerebrospinal fluid. The tubing is burrowed under your skin to your abdomen, where the shunt releases the excess fluid. A shunt is generally considered only if other treatments haven't relieved your condition. Shunts can clog and often require other surgeries to keep them working. Complications can include low-pressure headaches and infections.
Venous sinus stenting. This relatively new procedure is rarely used. It involves placing a stent in one of the larger veins in the head to increase the blood's ability to flow. More study is needed to determine the benefits and risks of this procedure.
Once you've had pseudotumor cerebri, you'll need to have your vision checked regularly to monitor changes.
