Pseudotumor Cerebri

Pseudotumor Cerebri Overview and Diagnosis

Pseudotumor cerebri occurs when the intracranial pressure (the pressure inside the skull) increases. This can happen for no apparent reason. The symptoms of pseudotumor cerebri mimic the brain tumor symptoms. However, there is no any tumor (that is why it is called “pseudo” tumor cerebri). It can occur in both adults and children.

If there is no any underlying cause for high intracranial pressure, pseudotumor cerebri is referred to as “idiopathic intracranial hypertension”.

This condition can lead to swelling of the optic nerve, which may lead to vision loss. In most cases, medications can be used to reduce the pressure. Some cases of pseudotumor cerebri require surgery.

What Are the Most Common Symptoms?

• Ringing in the ears and pulsing
• Photopsia (you see light flashes)
• Vomiting
• Nausea
• Double vision
• Dizziness
• Back pain
• Neck pain
• Blurred vision
• Headaches (you may have moderate or severe pain around the eyes. This pain can worsen as you move your eyes)
• Visual obscurations that last several seconds

Pseudotumor Cerebri Causes

The causes are still unknown; however, doctors believe that pseudotumor cerebri can be caused by too much cerebrospinal fluid in the skull. The spinal cord and brain are surrounded by this fluid (it is produced by the brain and its purpose is to protect the tissues). If the fluid isn’t properly absorbed, this can increase the intracranial pressure.

Brain tumors can also increase the pressure in the skull, because there is no enough room in the skull (for the tumor). Intracranial pressure can also increase if the brain swells.

Pseudotumor cerebri is also seen in people who have stenosis in large sinuses (transverse sinuses); however, it is still unclear whether stenosis (narrowing) can cause pseudotumor cerebri.

What Are the Risk Factors?

The following problems are associated with pseudotumor cerebri:

- Head injury
- Mononucleosis
- Kidney disease
- Underactive parathyroid glands
- Addison’s disease
- Lupus
- Lyme disease
- Sleep apnea
- Polycystic ovary syndrome
- Obesity

The use of certain substances can increase the risk of pseudotumor cerebri:

- Tetracycline
- Growth hormone
- Extremely large doses of vitamin A
- Oral contraceptives

Nearly 10 % of people who have pseudotumor cerebri also have problems with vision, and can become blind eventually.

Pseudotumor Cerebri Diagnosis

• Brain imaging: MRI or CT scans will rule out other conditions with similar symptoms (blood clots, brain tumors, etc).

• Eye examination: a doctor will look for papilledema (swelling) in the back of the patient’s eye. Visual fields tests can also be used.

• Lumbar puncture (spinal tap) can be used in measuring the pressure in the skull. A needle is inserted between two vertebrae located in the lower back.

How to Treat Pseudotumor Cerebri

This condition is treated with medications (in most cases). Obese individuals, who have pseudotumor cerebri, are strongly advised to lose weight. In patients who have problems with vision, surgery can be done to reduce the pressure.

• Glaucoma medications can be part of the treatment. These medications reduce the cerebrospinal fluid production.

• Migraine medications can help you relieve the headache caused by pseudotumor cerebri.

• Diuretics can be used to reduce fluid retention and prevent swelling.

Pseudotumor Cerebri Surgery

• Spinal fluid shunt: a thin tube is inserted into the brain to drain away cerebrospinal fluid; the tubing goes to the abdomen, and that is where the shunt discharges the cerebrospinal fluid.

• Optic nerve sheath fenestration is another method, but it is not always successful. Sometimes, it can make vision problems worse.