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===Natural History=== | ===Natural History=== | ||
The symptoms of pseudotumor cerebri usually develop in the mean age of 31 mostly in obese women with headache as the most common presenting sign. | * The [[Symptom|symptoms]] of pseudotumor cerebri usually develop in the mean age of 31 mostly in [[Obesity|obese]] women with [[headache]] as the most common presenting [[Sign (medical)|sign]]. | ||
* The other [[Symptom|symptoms]] of increased [[intracranial pressure]] may develop in patients such as Transient visual obscuration<ref name="pmid1998880">{{cite journal |vauthors=Wall M, George D |title=Idiopathic intracranial hypertension. A prospective study of 50 patients |journal=Brain |volume=114 ( Pt 1A) |issue= |pages=155–80 |date=February 1991 |pmid=1998880 |doi= |url=}}</ref><ref name="pmid1992368">{{cite journal |vauthors=Giuseffi V, Wall M, Siegel PZ, Rojas PB |title=Symptoms and disease associations in idiopathic intracranial hypertension (pseudotumor cerebri): a case-control study |journal=Neurology |volume=41 |issue=2 ( Pt 1) |pages=239–44 |date=February 1991 |pmid=1992368 |doi= |url=}}</ref>, Pulse synchronous [[tinnitus]]<ref name="pmid1992368">{{cite journal |vauthors=Giuseffi V, Wall M, Siegel PZ, Rojas PB |title=Symptoms and disease associations in idiopathic intracranial hypertension (pseudotumor cerebri): a case-control study |journal=Neurology |volume=41 |issue=2 ( Pt 1) |pages=239–44 |date=February 1991 |pmid=1992368 |doi= |url=}}</ref><ref name="pmid2293699">{{cite journal |vauthors=Sismanis A, Butts FM, Hughes GB |title=Objective tinnitus in benign intracranial hypertension: an update |journal=Laryngoscope |volume=100 |issue=1 |pages=33–6 |date=January 1990 |pmid=2293699 |doi=10.1288/00005537-199001000-00008 |url=}}</ref>, [[Photopsia]]<ref name="pmid1992368">{{cite journal |vauthors=Giuseffi V, Wall M, Siegel PZ, Rojas PB |title=Symptoms and disease associations in idiopathic intracranial hypertension (pseudotumor cerebri): a case-control study |journal=Neurology |volume=41 |issue=2 ( Pt 1) |pages=239–44 |date=February 1991 |pmid=1992368 |doi= |url=}}</ref>, neck and back pain and stiffness<ref name="pmid1998880">{{cite journal |vauthors=Wall M, George D |title=Idiopathic intracranial hypertension. A prospective study of 50 patients |journal=Brain |volume=114 ( Pt 1A) |issue= |pages=155–80 |date=February 1991 |pmid=1998880 |doi= |url=}}</ref><ref name="pmid1475750">{{cite journal |vauthors=Lessell S |title=Pediatric pseudotumor cerebri (idiopathic intracranial hypertension) |journal=Surv Ophthalmol |volume=37 |issue=3 |pages=155–66 |date=1992 |pmid=1475750 |doi= |url=}}</ref>, retrobulbar pain<ref name="pmid2289234">{{cite journal |vauthors=Wall M |title=The headache profile of idiopathic intracranial hypertension |journal=Cephalalgia |volume=10 |issue=6 |pages=331–5 |date=December 1990 |pmid=2289234 |doi=10.1046/j.1468-2982.1990.1006331.x |url=}}</ref>, horizontal [[diplopia]]<ref name="pmid1774176">{{cite journal |vauthors=Chari C, Rao NS |title=Benign intracranial hypertension--its unusual manifestations |journal=Headache |volume=31 |issue=9 |pages=599–600 |date=October 1991 |pmid=1774176 |doi= |url=}}</ref>, [[Vision loss|visual loss]]<ref name="pmid1998880">{{cite journal |vauthors=Wall M, George D |title=Idiopathic intracranial hypertension. A prospective study of 50 patients |journal=Brain |volume=114 ( Pt 1A) |issue= |pages=155–80 |date=February 1991 |pmid=1998880 |doi= |url=}}</ref>. If left untreated, vision loss may occur which is the most serious [[Complications|complication]] of this disease.<ref name="pmid1998880">{{cite journal |vauthors=Wall M, George D |title=Idiopathic intracranial hypertension. A prospective study of 50 patients |journal=Brain |volume=114 ( Pt 1A) |issue= |pages=155–80 |date=February 1991 |pmid=1998880 |doi= |url=}}</ref> | |||
===Complications=== | ===Complications=== | ||
Common complications of pseudotumor cerebri include: | * Common [[complications]] of pseudotumor cerebri include: | ||
==== Vision loss<ref name="pmid1998880">{{cite journal |vauthors=Wall M, George D |title=Idiopathic intracranial hypertension. A prospective study of 50 patients |journal=Brain |volume=114 ( Pt 1A) |issue= |pages=155–80 |date=February 1991 |pmid=1998880 |doi= |url=}}</ref> ==== | |||
==== complications from treatment ==== | |||
* [[Acetazolamide]] and [[furosemide]] can cause [[sulfa drug]] reactions.<ref name="pmid15234289">{{cite journal |vauthors=Lee AG, Anderson R, Kardon RH, Wall M |title=Presumed "sulfa allergy" in patients with intracranial hypertension treated with acetazolamide or furosemide: cross-reactivity, myth or reality? |journal=Am. J. Ophthalmol. |volume=138 |issue=1 |pages=114–8 |date=July 2004 |pmid=15234289 |doi=10.1016/j.ajo.2004.02.019 |url=}}</ref> | |||
* [[Analgesics]] can cause [[Rebound headache|rebound headaches]]<ref name="pmid12034799">{{cite journal |vauthors=Friedman DI, Rausch EA |title=Headache diagnoses in patients with treated idiopathic intracranial hypertension |journal=Neurology |volume=58 |issue=10 |pages=1551–3 |date=May 2002 |pmid=12034799 |doi= |url=}}</ref> | |||
* Optic nerve sheath fenestration can cause temporary [[diplopia]], papillary dysfunction<ref name="pmid3178548">{{cite journal |vauthors=Brourman ND, Spoor TC, Ramocki JM |title=Optic nerve sheath decompression for pseudotumor cerebri |journal=Arch. Ophthalmol. |volume=106 |issue=10 |pages=1378–83 |date=October 1988 |pmid=3178548 |doi= |url=}}</ref> and temporary or permanent vision loss.<ref name="pmid8493011">{{cite journal |vauthors=Plotnik JL, Kosmorsky GS |title=Operative complications of optic nerve sheath decompression |journal=Ophthalmology |volume=100 |issue=5 |pages=683–90 |date=May 1993 |pmid=8493011 |doi= |url=}}</ref> | |||
* Shunting can cause [[shunt infection]], abdominal and back pain, [[radicular pain]], and [[cerebrospinal fluid]] leak with low pressure<ref name="pmid9305333">{{cite journal |vauthors=Burgett RA, Purvin VA, Kawasaki A |title=Lumboperitoneal shunting for pseudotumor cerebri |journal=Neurology |volume=49 |issue=3 |pages=734–9 |date=September 1997 |pmid=9305333 |doi= |url=}}</ref> | |||
===Prognosis=== | ===Prognosis=== | ||
The prognosis varies in IIH patients. Treatment of IIH patients may lead to improvement or stabilization but in many of them we have persistent papilledema and increased intracranial hypertension. Some of these patients have a more progressive course which leads to vision loss.<ref name="pmid17224579">{{cite journal |vauthors=Thambisetty M, Lavin PJ, Newman NJ, Biousse V |title=Fulminant idiopathic intracranial hypertension |journal=Neurology |volume=68 |issue=3 |pages=229–32 |date=January 2007 |pmid=17224579 |doi=10.1212/01.wnl.0000251312.19452.ec |url=}}</ref><ref name="pmid8023881">{{cite journal |vauthors=Liu GT, Glaser JS, Schatz NJ |title=High-dose methylprednisolone and acetazolamide for visual loss in pseudotumor cerebri |journal=Am. J. Ophthalmol. |volume=118 |issue=1 |pages=88–96 |date=July 1994 |pmid=8023881 |doi= |url=}}</ref><ref name="pmid2769395">{{cite journal |vauthors=Kidron D, Pomeranz S |title=Malignant pseudotumor cerebri. Report of two cases |journal=J. Neurosurg. |volume=71 |issue=3 |pages=443–5 |date=September 1989 |pmid=2769395 |doi=10.3171/jns.1989.71.3.0443 |url=}}</ref> Even in patients who undergo recovery there is 8 to 38 percent of symptom recurrence.<ref name="pmid7103794">{{cite journal |vauthors=Corbett JJ, Savino PJ, Thompson HS, Kansu T, Schatz NJ, Orr LS, Hopson D |title=Visual loss in pseudotumor cerebri. Follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss |journal=Arch. Neurol. |volume=39 |issue=8 |pages=461–74 |date=August 1982 |pmid=7103794 |doi= |url=}}</ref> The presence of high grade papilledema or transient visual obscurations is a sign indicating higher risk of permanent vision loss in patient.<ref name="pmid2247234">{{cite journal |vauthors=Wall M |title=Sensory visual testing in idiopathic intracranial hypertension: measures sensitive to change |journal=Neurology |volume=40 |issue=12 |pages=1859–64 |date=December 1990 |pmid=2247234 |doi= |url=}}</ref> | * The [[prognosis]] varies in [[Idiopathic intracranial hypertension|IIH]] patients. Treatment of [[Idiopathic intracranial hypertension|IIH]] patients may lead to improvement or stabilization but in many of them we have persistent [[papilledema]] and increased [[intracranial hypertension]]. Some of these patients have a more progressive course which leads to [[vision loss]].<ref name="pmid17224579">{{cite journal |vauthors=Thambisetty M, Lavin PJ, Newman NJ, Biousse V |title=Fulminant idiopathic intracranial hypertension |journal=Neurology |volume=68 |issue=3 |pages=229–32 |date=January 2007 |pmid=17224579 |doi=10.1212/01.wnl.0000251312.19452.ec |url=}}</ref><ref name="pmid8023881">{{cite journal |vauthors=Liu GT, Glaser JS, Schatz NJ |title=High-dose methylprednisolone and acetazolamide for visual loss in pseudotumor cerebri |journal=Am. J. Ophthalmol. |volume=118 |issue=1 |pages=88–96 |date=July 1994 |pmid=8023881 |doi= |url=}}</ref><ref name="pmid2769395">{{cite journal |vauthors=Kidron D, Pomeranz S |title=Malignant pseudotumor cerebri. Report of two cases |journal=J. Neurosurg. |volume=71 |issue=3 |pages=443–5 |date=September 1989 |pmid=2769395 |doi=10.3171/jns.1989.71.3.0443 |url=}}</ref> Even in patients who undergo recovery there is 8 to 38 percent of [[symptom]] recurrence.<ref name="pmid7103794">{{cite journal |vauthors=Corbett JJ, Savino PJ, Thompson HS, Kansu T, Schatz NJ, Orr LS, Hopson D |title=Visual loss in pseudotumor cerebri. Follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss |journal=Arch. Neurol. |volume=39 |issue=8 |pages=461–74 |date=August 1982 |pmid=7103794 |doi= |url=}}</ref> The presence of high grade [[papilledema]] or transient visual obscurations is a [[Sign (medical)|sign]] indicating higher risk of permanent vision loss in patient.<ref name="pmid2247234">{{cite journal |vauthors=Wall M |title=Sensory visual testing in idiopathic intracranial hypertension: measures sensitive to change |journal=Neurology |volume=40 |issue=12 |pages=1859–64 |date=December 1990 |pmid=2247234 |doi= |url=}}</ref> | ||
==References== | ==References== | ||
Latest revision as of 14:33, 29 November 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Natural History, Complications, and Prognosis
Natural History
- The symptoms of pseudotumor cerebri usually develop in the mean age of 31 mostly in obese women with headache as the most common presenting sign.
- The other symptoms of increased intracranial pressure may develop in patients such as Transient visual obscuration[1][2], Pulse synchronous tinnitus[2][3], Photopsia[2], neck and back pain and stiffness[1][4], retrobulbar pain[5], horizontal diplopia[6], visual loss[1]. If left untreated, vision loss may occur which is the most serious complication of this disease.[1]
Complications
- Common complications of pseudotumor cerebri include:
Vision loss[1]
complications from treatment
- Acetazolamide and furosemide can cause sulfa drug reactions.[7]
- Analgesics can cause rebound headaches[8]
- Optic nerve sheath fenestration can cause temporary diplopia, papillary dysfunction[9] and temporary or permanent vision loss.[10]
- Shunting can cause shunt infection, abdominal and back pain, radicular pain, and cerebrospinal fluid leak with low pressure[11]
Prognosis
- The prognosis varies in IIH patients. Treatment of IIH patients may lead to improvement or stabilization but in many of them we have persistent papilledema and increased intracranial hypertension. Some of these patients have a more progressive course which leads to vision loss.[12][13][14] Even in patients who undergo recovery there is 8 to 38 percent of symptom recurrence.[15] The presence of high grade papilledema or transient visual obscurations is a sign indicating higher risk of permanent vision loss in patient.[16]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Wall M, George D (February 1991). "Idiopathic intracranial hypertension. A prospective study of 50 patients". Brain. 114 ( Pt 1A): 155–80. PMID 1998880.
- ↑ 2.0 2.1 2.2 Giuseffi V, Wall M, Siegel PZ, Rojas PB (February 1991). "Symptoms and disease associations in idiopathic intracranial hypertension (pseudotumor cerebri): a case-control study". Neurology. 41 (2 ( Pt 1)): 239–44. PMID 1992368.
- ↑ Sismanis A, Butts FM, Hughes GB (January 1990). "Objective tinnitus in benign intracranial hypertension: an update". Laryngoscope. 100 (1): 33–6. doi:10.1288/00005537-199001000-00008. PMID 2293699.
- ↑ Lessell S (1992). "Pediatric pseudotumor cerebri (idiopathic intracranial hypertension)". Surv Ophthalmol. 37 (3): 155–66. PMID 1475750.
- ↑ Wall M (December 1990). "The headache profile of idiopathic intracranial hypertension". Cephalalgia. 10 (6): 331–5. doi:10.1046/j.1468-2982.1990.1006331.x. PMID 2289234.
- ↑ Chari C, Rao NS (October 1991). "Benign intracranial hypertension--its unusual manifestations". Headache. 31 (9): 599–600. PMID 1774176.
- ↑ Lee AG, Anderson R, Kardon RH, Wall M (July 2004). "Presumed "sulfa allergy" in patients with intracranial hypertension treated with acetazolamide or furosemide: cross-reactivity, myth or reality?". Am. J. Ophthalmol. 138 (1): 114–8. doi:10.1016/j.ajo.2004.02.019. PMID 15234289.
- ↑ Friedman DI, Rausch EA (May 2002). "Headache diagnoses in patients with treated idiopathic intracranial hypertension". Neurology. 58 (10): 1551–3. PMID 12034799.
- ↑ Brourman ND, Spoor TC, Ramocki JM (October 1988). "Optic nerve sheath decompression for pseudotumor cerebri". Arch. Ophthalmol. 106 (10): 1378–83. PMID 3178548.
- ↑ Plotnik JL, Kosmorsky GS (May 1993). "Operative complications of optic nerve sheath decompression". Ophthalmology. 100 (5): 683–90. PMID 8493011.
- ↑ Burgett RA, Purvin VA, Kawasaki A (September 1997). "Lumboperitoneal shunting for pseudotumor cerebri". Neurology. 49 (3): 734–9. PMID 9305333.
- ↑ Thambisetty M, Lavin PJ, Newman NJ, Biousse V (January 2007). "Fulminant idiopathic intracranial hypertension". Neurology. 68 (3): 229–32. doi:10.1212/01.wnl.0000251312.19452.ec. PMID 17224579.
- ↑ Liu GT, Glaser JS, Schatz NJ (July 1994). "High-dose methylprednisolone and acetazolamide for visual loss in pseudotumor cerebri". Am. J. Ophthalmol. 118 (1): 88–96. PMID 8023881.
- ↑ Kidron D, Pomeranz S (September 1989). "Malignant pseudotumor cerebri. Report of two cases". J. Neurosurg. 71 (3): 443–5. doi:10.3171/jns.1989.71.3.0443. PMID 2769395.
- ↑ Corbett JJ, Savino PJ, Thompson HS, Kansu T, Schatz NJ, Orr LS, Hopson D (August 1982). "Visual loss in pseudotumor cerebri. Follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss". Arch. Neurol. 39 (8): 461–74. PMID 7103794.
- ↑ Wall M (December 1990). "Sensory visual testing in idiopathic intracranial hypertension: measures sensitive to change". Neurology. 40 (12): 1859–64. PMID 2247234.