Our topic continues with
subacute and chronic headache.
Here, we’ll take a look
at pseudotumor cerebri.
Who’s your patient?
Patient comes in with
this chronic headache,
also called idiopathic
In other words, this is your ICH.
Now, idiopathic because we don’t
know exactly as to what causes it.
We do know that there’s a particular drug
that you should be extremely familiar with
that might be a possible etiology, and
that’s your ATRA, all-trans retinoic acid.
Well, pseudotumor cerebri, as the
name implies, pseudo means false,
a tumor-like lesion,
or should I say
By that, we mean there’s
a headache taking place.
You’ll find papilledema on
fundoscopic examination but
absolutely no evidence of a tumor.
Described as diffuse,
dull, ache, pressure.
Remember, this is
Onset is a gradual but
Headache is often worsened by laying
down and by physical activity.
Blurred vision is common.
Horizontal diplopia is occasionally seen,
and bilateral cranial nerve VI
abducens palsy can be seen.
So this will be a good time
to review quickly, please,
the functions of your
abducens cranial nerve VI,
And papilledema is
Keep that in mind.
What does papilledema
mean to you?
You do a fundoscopic examination
and you find there around optic
disc, it looks like sun rays.
Very bright, huh?
That’s your papilledema.
Now, with that papilledema,
you would think that,
“Oh my goodness, that
must be prominent.”
You’re worried about intracranial
pressure being increased,
and that is not a good thing.
So, keep that in mind.
We’ll take a look at epidemiology
of pseudotumor cerebri.
75% of your patients
will be females.
That’s where your
focus should be.
will be in her reproductive
age between 20 to 40.
Vast majority of these
females are obese,
more common during pregnancy,
also seen with steroid therapy,
vitamin A toxicity, which I
was referring to earlier,
your ATRA, all-trans retinoic acid,
and maybe perhaps, even
I have no freaking clue,
but make sure you know that
these are possible causes
or medications that may result as an
adverse effect of pseudotumor cerebri.
Diagnosis: Imaging initially to rule out
a mass lesion because there is no mass.
Lumbar puncture to document --
document -- opening pressure.
elevated at 250 to 450 millimeters,
the water pressure in
It is important that you know the
specifics for opening pressure, please.
CSF should otherwise be normal.
Formal visual field testing
because of papilledema.
Early defect is enlargement of blind spot
and slight peripheral field constriction.
Remember, there is prominent
papilledema in these patients,
so early on, you would
find such defects.
Well, here, lumbar
puncture to make sure that
you’ve figured out what
that opening pressure is,
optic nerve fenestrations.
You do want to relieve some of
that pressure that’s taking place
with idiopathic intracranial
hypertension, AKA, pseudotumor cerebri.
Summary of pseudotumor cerebri:
early, young, obese.
Preventive medicine: Weight loss.
Signs and symptoms:
Blurred vision, headache.
The differentials include, if you remember,
we talked about venous sinus
thrombosis during pregnancy.
Please be very careful,
because during pregnancy with estrogen,
it may result in the thrombus formation
in the sagittal or the transverse sinus.
I even showed you an image where
the transverse sinus was absent.
That’s venous sinus thrombosis.
Here, we have pseudotumor, mass lesion,
migraines as being differentials.
Diagnostic: Lumbar puncture.
We talked about earlier,
specifically the pressure of 250
to 450 millimeters of water.
Treatment: Weight loss, carbonic
anhydrase inhibitors, and shunting.