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Treatment of pseudotumor cerebri

by — Last updated: 2013-12-19 in Nervous System Disorders and Diseases

Table of Contents

Idiopathic Intracranial Hypertension is a specific condition characterized by high pressure in the fluid around the brain. It is also known as pseudotumor cerebri which literally means false brain tumor, because it's symptoms mimic those of brain tumors.



Treatment for patient with intracranial hypertension can be divided into:

  • medical treatment
  • surgical treatment

Medical treatment

Weight loss

The cornerstone of IIH medical treatment is weight loss. It may be the loss of fluid accompanying weight loss that is the significant factor but this has not been proven.
Even losing weight at a really slow pace may prove beneficial.

Fluid loss

Loss of fluid can also be obtained using diuretics (fluid pills).

Medications

Acetazolamide (Diamox ®) is the most commonly used medication. It is relatively safe but nearly all patients experience tingling of the fingers and toes as side effects. Patients may also notice that carbonated soft drinks taste metallic after using this medicine.  Another diuretic commonly used that appears to be effective in some patients is  Furosemide (Lasix®).

Corticosteroids are also very effective in lowering the intracranial pressure in those patients with idiopathic intracranial hypertension.

Surgical treatment

Optic nerve sheath fenestration

This procedure is based on surgeons making slits in the optic nerve sheath or covering. It is only used when patients do not respond adequately to medical therapy. The operation of fenestration is done first by an incision into the orbit. The eyeball is moved to the side and the optic nerve sheath is exposed. Slits or a large hole are then placed in the optic nerve sheath and fluid drains out, thereby taking pressure off the optic nerve.

Complications related to this procedure include:

  • diplopia,
  • optic nerve injury,
  • vascular occlusion,
  • a tonic pupil,
  • the inherent risk of hemorrhage
  • infection


Cerebrospinal fluid diversion procedures

Two neurosurgical interventions are highly effective in lowering the intracranial pressure: lumbo-peritoneal and ventriculo-peritoneal shunt. Lumboperitoneal shunts drain from the lumbar spine to the peritoneal cavity, while ventriculoatrial shunts run from the cerebral ventricles to the heart.
They represent the procedures of choice for treating patients with idiopathic intracranial hypertension who do not respond to maximum medical treatment. Unfortunately, these procedures have some complications.The most severe one is that some patients have periodic occlusion of the tubing with recurrence of symptoms and sometimes vision loss.

Appropriate diet

There is no doubt that weight reduction is definitely an important factor in the long-term management of these patients. Although As little as a 6% decrease in the total body weight can result in the resolution of papilledema. Unfortunately, weight loss in patients who are obese is difficult.

Preventing visual loss

Several researches have proven that the best way to prevent visual loss is to test vision regularly. Intracranial hypertension is a life-long disease but its’ symptoms are very treatable and, if treatment is started early enough, the vision loss is reversible.

Prognosis

The prognosis is good for most patients if they get an adequat treatment. This condition becomes chronic in rare cases only, and even then, long term medication may be sufficient to control the condition.