Overview
Diagnosis
To diagnose pseudotumor cerebri, a health care provider reviews symptoms and medical history, performs a physical examination and recommends specific tests. Eye exams are a key part of diagnosis. An ophthalmologist looks for swelling of the optic nerve and may perform a visual field test to find any blind spots beyond the normal ones. Imaging such as optical coherence tomography may be used to measure the thickness of the retina layers. Brain imaging with MRI or CT scans helps rule out other causes, including tumors or blood clots. A spinal tap may also be done to measure the pressure inside the skull and analyze cerebrospinal fluid. This test involves removing a small amount of fluid from the lower back with a needle for laboratory analysis.
Treatment
Treatment aims to relieve symptoms and protect vision from further damage. Weight loss may be recommended for those who are obese, often with support from a dietitian or a structured program, and in some cases gastric surgery. Medicines are commonly used to manage symptoms. Acetazolamide, a glaucoma medication, can reduce the production of cerebrospinal fluid, though it may cause tingling sensations, stomach upset, fatigue or kidney stones. Other diuretics may be added if needed to help reduce fluid retention. Migraine medications may help ease severe headaches.
Surgery may be considered if vision continues to worsen. An optic nerve sheath fenestration creates a small opening in the membrane surrounding the optic nerve to release excess fluid. Many people experience improved or stabilized vision after this procedure, though it is not always successful. Another option is a spinal fluid shunt, in which a tube drains excess fluid from the brain or spine into the abdomen. Shunts can become blocked and may require additional surgeries, and complications such as low-pressure headaches or infections can occur. Venous sinus stenting is a newer, less common procedure that increases blood flow in one of the major veins in the head, though more research is needed to understand its benefits. Regular vision checks are important after treatment to monitor for any changes.
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