Overview
Pseudotumor cerebri treatment typically begins with medications to control the symptoms. Weight loss is recommended for obese individuals. If your vision worsens, surgery to reduce the pressure around your optic nerve or to decrease the intracranial pressure may be necessary.
Pseudotumor cerebri is a condition that mimics symptoms of a brain tumor and literally means "false brain tumor." It is due to a buildup of pressure in the cerebrospinal fluid inside the skull. Pseudotumor cerebri can cause vision problems and severe headaches.
This condition is typically treated non-surgically through weight loss and medications. For severe cases of pseudotumor cerebri that don't respond to these treatments, surgery may be necessary.
Ventriculoperitoneal (VP) shunts are used to drain excess fluid and relieve pressure on the brain. UPMC neurosurgeons use state-of-the-art image guidance to place VP shunts.
Medications
- Glaucoma drugs. One of the first drugs usually tried is acetazolamide (Diamox), a glaucoma drug that reduces the production of cerebrospinal fluid by at least 50 percent. Possible side effects include stomach upset; fatigue; tingling of fingers, toes and mouth; and kidney stones.
- Diuretics. If acetazolamide alone isn't effective, it's sometimes combined with furosemide, a potent diuretic that reduces fluid retention by increasing urine output.
- Migraine medications. Medications typically prescribed to relieve migraines can sometimes ease the severe headaches that often accompany pseudotumor cerebri.
- Eye exams If pseudotumor cerebri is suspected, a doctor specializing in eye disorders will look for a distinctive type of swelling — called papilledema — in the back of your eye. You will also undergo a visual fields test to see if there are any blind spots in your vision.
- Brain imaging CT or MRI scans can rule out other problems that can cause similar symptoms, such as brain tumors and blood clots.
- Spinal tap (lumbar puncture) A lumbar puncture — which involves inserting a needle between two vertebrae in your lower back — can determine how high the pressure is inside your skull.
Eye exams
If pseudotumor cerebri is suspected, a doctor specializing in eye disorders will look for a distinctive type of swelling — called papilledema — in the back of your eye. You will also undergo a visual fields test to see if there are any blind spots in your vision.Brain imaging
CT or MRI scans can rule out other problems that can cause similar symptoms, such as brain tumors and blood clots.Spinal tap (lumbar puncture)
A lumbar puncture — which involves inserting a needle between two vertebrae in your lower back — can determine how high the pressure is inside your skull.Surgery
- Optic nerve sheath fenestration This procedure cuts a window into the membrane that surrounds the optic nerve. This allows excess cerebrospinal fluid to escape. Vision stabilizes or improves in more than 85 percent of 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 may even increase vision problems.
- Spinal fluid shunt Another type of surgery inserts a long, thin tube — called a shunt — into your brain or lower spine to help drain away excess cerebrospinal fluid. The tubing is burrowed under your skin to your abdomen, where the shunt discharges the excess fluid. Symptoms improve for more than 80 percent of the people who undergo this procedure. But shunts can become clogged and often require additional surgeries to keep them working properly. Complications can include low-pressure headaches and infections.
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