What is Pseudotumor Cerebri, Know its Symptoms, Risks, Diagnosis and Treatment

Pseudotumor cerebri is a medical condition in which there is increased pressure inside the skull due to an increase in fluid accumulation. Pseudotumor cerebri is a false tumor as many of the symptoms of this condition mimic tumor. It is also known as idiopathic hypertension as there is no certain cause of raised intracranial pressure in this condition⁽¹⁾.

Cerebrospinal fluid is produced inside the brain cavities that lubricate the coverings of the brain. If there is an increase in production or reduced absorption, CSF accumulates. This can lead to pseudotumor cerebri.

If not treated, Pseudotumor cerebri can lead to serious and permanent complications such as progressive or permanent loss of vision.

Depending on the onset and duration of symptoms, there are two types of pseudotumor cerebri:

• Acute pseudotumor cerebri: In this, the symptoms happen suddenly mostly after a head injury or stroke.
• Chronic pseudotumor cerebri: In this, the symptoms occur gradually over time and may be due to an underlying medical condition.

The signs and symptoms of pseudotumor cerebri mimic those of brain tumor and include⁽²⁾:

• Loss of vision
• Neck stiffness
• Dizziness
• Diplopia
• Blurred vision
• Nausea with or without vomiting
• Headache
• Ringing in the ear
• Depression
• Forgetfulness
• Difficulty in walking

The symptoms of this condition may worsen on straining or exerting during exercise. This is because exercise raises the intracranial pressure.

Pseudotumor cerebri is common in women aged 20-50 years. The conditions that increase its risk are:

• Anemia
• Addison’s disease
• Lupus
• Behcet’s syndrome
• Blood clotting problem
• Measles
• Sleep apnea
• Lyme disease
• Kidney disease
• Polycystic ovary disease
• Underactive thyroid glands

Also, certain medications also increase the risk, which includes certain antibiotics, birth control pills, steroids, vitamin A based drugs, and growth hormones.

To diagnose the condition, the doctor first takes a medical history and detailed symptoms. The doctor checks the optic nerve with an ophthalmoscope to see if it’s swollen. A few tests that may help diagnose this condition include:

Spinal Tap: This procedure involves inserting a needle into the lower back and removing a small amount of fluid from around the spine. This test can help in testing the pressure of fluid inside the skull.

Computed Tomography: This helps in taking a detailed picture of the brain.

Magnetic Resonance Imaging (MRI): These are the powerful magnetic and radio waves that can detect increased pressure and abnormal growths in the brain.

Vision Test: Regular vision tests are done to look for the swelling of the optic nerve in the back of the eye.

Pseudotumor cerebri is treated by medications and surgery and can also recur in some people despite treatment. This is why regular check-up with the doctor and monitoring of the symptoms is necessary.

The treatment of Pseudotumor cerebri depends on the underlying condition and the severity of the symptoms. The treatment includes the following ⁽³⁾:

• Weight loss is important for people who are overweight or obese. This can be obtained by a change in lifestyle and surgery.
• Limited intake of salt and fluid is needed.
• Surgery is recommended to reduce intracranial pressure. Therapeutic shunting is done that involves surgical placement of a shunt to drain the cerebrospinal fluid from the lower spine into the abdomen. This reduces intracranial pressure.
• A spinal tap is done for the removal of excess fluid through a lumbar puncture.
• There are a few medications that reduce fluid build-up. These include diuretics that help in removing excess fluid from the body.

The pressure in the brain goes down in a few months of treatment and the patient starts feeling better. Most people recover from Pseudotumor cerebri, but a few may suffer from permanent vision loss. It is therefore important to see the doctor regularly and get regular eye check-ups.