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Pseudotumor cerebri

Definition


Disease: Pseudotumor cerebri Pseudotumor cerebri
Category: Neurological diseases
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Disease Definition:

When pressure inside the skull (intracranial pressure) is increased without there being any specific reason behind it a condition known as pseudotumor cerebri (SOO-doh-too-mur SER-uh-bry) takes place. Symptoms are similar to those of a brain tumor but without a tumor’s existence. This condition most commonly takes place in obese women of childbearing age, even though it might affect children and adults as well.
If increased intracranial pressure doesn’t have a certain cause underlying it, pseudotumor cerebri might additionally be known as idiopathic intracranial hypertension. Swelling of the optic nerve could result from high intracranial pressure related to pseudotumor cerebri causing vision loss. This pressure usually could be decreased with the use of medications, but sometimes, surgery might be necessary.

Work Group:


Prepared by: Scientific Section

Symptoms, Causes

Symptoms:

The followings are symptoms of pseudotumor cerebri:

  • Ringing in the ears pulsing in time with the heartbeat.
  • Blurred or dimmed vision.
  • Difficulty seeing to the side.
  • Moderate to severe headaches that might arise behind the eyes, disrupting one’s sleep and worsening with eye movement.
  • Double vision.
  • Nausea, dizziness or vomiting.
  • Brief episodes of blindness, lasting only a few seconds and affecting one or both eyes.

Causes:

While excess amount of cerebrospinal fluid within the bony confines of the skull might be related to the occurrence of pseudotumor cerebri, even though mostly it isn’t known why.
A person’s brain and spinal cord are surrounded by cerebrospinal fluid acting like a cushion to protect these vital tissues from injury. This fluid is produced in the brain and finally is absorbed into the bloodstream. The high intracranial pressure of pseudotumor cerebri might be the outcome of a problem in this absorption process.
The intracranial pressure generally increases when the contents of the skull exceed its capacity. For instance, a brain tumor commonly raises the intracranial pressure due to the inability to find a space for it, similar to the condition of swelling of the brain or when having too much cerebrospinal fluid.

The followings aspects have been related to pseudotumor cerebri:

Obesity
Pseudotumor cerebri takes place in about one person per 100,000 in the general public. Obese women under the age of 44 are almost 20 times likely to grow the disorder.

Medications
The followings are the substances related to pseudotumor cerebri:

  • Oral contraceptives.
  • Excess vitamin A.
  • Tetracycline.
  • Lithium.
  • Steroids or discontinuation of steroids.


Health problems
The following conditions and diseases have been related to pseudotumor cerebri:

  • Lupus.
  • Underactive parathyroid glands.
  • Head injury.
  • Mononucleosis.
  • Kidney disease.
  • Lyme disease.

Complications

Complications:

As many as 10% of the people suffering from pseudotumor cerebri has vision that gets worse in a progressive way that might finally become blind. Even in the case of symptoms being resolved, the condition might take place once again months or even years later.

Treatments:

Treatment for pseudotumor cerebri commonly starts with managing symptoms with the use of medications. Obese individuals having the condition should lose weight as recommended. In case the vision gets worse, surgery decreasing the pressure surrounding the optic nerve or reducing the intracranial pressure might be necessary.

Medications

  • Glaucoma drugs. One of the initial medications often used is acetazolamide, a glaucoma medication decreasing the production of cerebrospinal fluid through at least 50%. Upset stomach, tingling of the toes, mouth and fingers, kidney stones and fatigue are all a part of the side effect.
  • Diuretics. In case acetazolamide is not effective on its own, it is occasionally combined with furosemide, a potent diuretic decreasing fluid retention through raising the urine output.
  • Migraine medications. Occasionally, severe headaches that usually accompany pseudotumor cerebri might be eased with the use of medications commonly prescribed in order to relieve migraines.


Surgery

  • Optic nerve sheath fenestration. This operation cuts a window into the membrane found around the optic nerve that allows extra cerebrospinal fluid to leak. Talking with figures, in more than 85% of the cases vision either stabilizes or gets better. Most people who go through this operation on one eye observe improvement in both eyes. Yet, the outcome of this surgery might not always be success and might even increase vision problems.
  • Spinal fluid shunt. A long thin tube is inserted in this kind of surgery that is known as a shunt into the brain or lower spine draining away the extra cerebrospinal fluid. The tubing is burrowed under the skin to the abdomen, where the shunt discharges the extra fluid. More than 80% of the cases indicate that symptoms get better for people who had undergone this operation. But shunts could become clogged and usually need additional surgeries to keep them working properly. Low-pressure headaches and infections might come out as complications of this surgery.

Prognosis:

Not available

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Consultants Corner

Dr. Tahsin Martini

Dr. Tahsin Martini Degree status: M.D. in Ophthalmology

Dr. Faisal Dibsi

Dr. Faisal Dibsi Specialist of Otolaryngology - Head and Neck Surgery

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

Dr . Dirar Abboud

Dr . Dirar Abboud Hepatologist – Gastroenterologist

Dr. Talal Sabouni

Dr. Talal Sabouni UROLOGY AND KIDNEY TRANSPLANT

Samir Moussa M.D.

Samir Moussa M.D. ENT Specialist

Dr. Samer Al-Jneidy

Dr. Samer Al-Jneidy Pediatrician

Dr. Hani Najjar

Dr. Hani Najjar Pediatrics, Neurology
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