Pseudotumor Cerebri Details

Pseudotumor Cerebri Symptoms

The common symptoms are headache, dizziness and impaired vision.

Headache is often worse on awakening, and can be intensified by coughing, laughing, bending over, crying, and increased physical activity.

Impaired vision shows up in several ways. It can be visual blurring, brief moments of dimming or loss of vision called transient visual obscurations (TVO's), small specks appearing or vision distortions (items moving up or down).

Blindness can occur.

Other symptoms affecting PTC patients include: shoulder/arm pain, neck pain, memory problems, awkward coordination, muscle weakness, fatigue, back pain, and depression.

Possible symptoms include dizziness, hearing loss, ringing in the ears or noises within the head called tinnitus.

Regarding headaches: a study showed 92% of patients interviewed had headaches; 93% of those with headaches said it was the most severe headache they had ever experienced. The head pain was described as a pulsing headache that kept increasing in intensity. Another description was a "pressure" headache, resembling a percolator. Seventy four percent of those with headaches had it on a daily basis. Can also experience neck stiffness or nausea.

Pseudotumor Cerebri Characteristics

By appearance, a person looks well.

PTC can last for months or for years. It can go into remission. For those in remission, PTC can re-occur 5% to 10% of the time.

80% of PTC patients have some positive response to treatment. (This means that the PTC symptoms improve, not that the PTC necessarily goes away.)

Pseudotumor Cerebri most commonly appears in women of child-bearing age. However, this disease also occurs in children and teenagers (both male and female) and adult males.

For women of child-bearing age, there is often a history of menstrual problems. Frequently these women are overweight and/or have had a recent weight gain.

Although physicians recommend weight loss, there are patients whose weight loss has not affected their PTC.

A number of PTC patients have had a previous history of sinus problems.

Many patients are light-sensitive; bright lights bother them and fluorescent light will fatigue and bring on confusion.

Endocrine studies can appear normal.

Often PTC is complicated with high blood pressure.

PTC does appear to have a relationship to adrenal hormones.

Things Linked to PTC

Secondary PTC has appeared with the use of oral contraceptives, prolonged use of corticosteroids, large doses of Vitamin A, use of tetracycline , nalidixic acid, nitrofurantoin, sulfa drugs, lithium, indomethacin, and phenytoin. Rapid recovery often occurs when drug use is stopped. Chlordane toxicity (an insecticide) can also cause PTC.

Other things linked to PTC include:

Tetracyclines (including doxycycline and minocycline, antibiotics for chlamydia and acne)

Lithium carbonate (a mineral salt to treat bipolar or manic-depressive disorder)

Systemic lupus erythematosus

Lyme disease

Addison's disease (a condition in which the adrenal glands hypofunction)

Cushing's disease (a condition in which the adrenal glands hyperfunction)

Prednisone (and other steroids, possibly by any route including topically, nasally, orally, etc.)

Hypo-thyroidism

Hyper-thyroidism

Pregnancy

Obesity

Head Trauma

Irritable Bowel Syndrome

Empty Sella Syndrome (condition in which the pituitary hypofunctions)

Licorice (the inciting ingredient is glycericic acid)

Vitamin A or its derivatives (used in bone marrow transplantation patients and to treat acne)

Respiratory infections

sleep apnea (a condition in which the patient snores and has headaches upon awakening)

Norplant (a contraceptive that is implanted under the skin)

Growth hormone therapy

Climacteric (the start of menopause)

Kidney disorders and kidney transplants

Had to correct my last post. Obesity has been linked to the condition not a symptom. Good information for those who don't know.

Looking forward not back,

Hmmm, very interesting. I have many of these headache symptoms. But I also have Intermitent (aka cyclical) Cushing's, most likey caused by the tumor in my Pit.

I'll be sure to research this more, and bring it to the attention of my Cushing's board.

MoM, can you please provide the link where you got the info?

Pseudotumor Cerebri

Signs and Symptoms

Pseudotumor cerebri (PTC) is encountered most frequently in young, overweight women between the ages of 20 and 45. Headache is the most common presenting complaint, occurring in more than 90 percent of cases. Dizziness, nausea, and vomiting may also be encountered, but typically there are no alterations of consciousness or higher cognitive function. Tinnitus, or a "rushing" sound in the ears, is another frequent complaint. Visual symptoms are present in up to 70 percent of all patients with PTC, and include transient visual obscurations, general blurriness, and intermittent horizontal diplopia. These symptoms tend to worsen in association with Valsalva maneuvers and changes in posture. Reports of ocular pain, particularly with extreme eye movements, have also been noted.

Funduscopic evaluation of patients with PTC demonstrates bilaterally swollen, edematous optic nerves consistent with true papilledema. Ophthalmoscopy may reveal striations within the nerve fiber layer, blurring of the superior and inferior margins of the neural rim, disc hyperemia, and capillary dilatation. More severe presentations involve engorged and tortuous retinal venules, peripapillary hemorrhages and/or cotton wool spots, and circumferential retinal microfolds (Paton’s lines). Chronic papilledema mayresult in atrophy of the nerve head, with associated pallor and gliosis. Most cases of true papilledema will not present with a relative afferent pupillary defect, although visual field deficits may be present. The most common visual field defect associated with PTC is an enlarged blind spot, followed by a nasal deficit, typically affecting the inferior quadrants. Other field losses seen in PTC include arcuate defects, nasal step, generalized constriction, and least commonly, cecocentral scotoma.

Pathophysiology

Pseudotumor cerebri is a syndrome disorder defined clinically by four criteria: (1) elevated intracranial pressure as demonstrated by lumbar puncture; (2) normal cerebral anatomy, as demonstrated by neuroradiographic evaluation; (3) normal cerebrospinal fluid composition; and (4) signs and symptoms of increased intracranial pressure, including papilledema.

While the mechanism of PTC is not fully understood, most experts agree that the disorder results from poor absorption of cerebrospinal fluid by the meninges surrounding the brain and spinal cord. The subsequent increase in extracerebral fluid volume leads to elevated intracranial pressure. However, because the process is slow and insidious, there is ample time for the ventricular system to compensate and this explains why there is no dilation of the cerebral ventricles in PTC. Increased intracranial pressure induces stress on the peripheral aspects of the brain, including the cranial nerves. Stagnation of axoplasmic flow in the optic nerve (CN II) results in papilledema and transient visual obscurations; when the abducens nerve (CN VI) is involved, the result is intermittent nerve palsy and diplopia.

Many conditions and factors have been proposed as causative agents of PTC, including excessive dosages of some exogenously administered medications (e.g., vitamin A, tetracycline, minocycline, naladixic acid, corticosteroids), endocrinologic abnormalities, anemias, blood dyscrasias, and chronic respiratory insufficiency. However the majority of cases remain idiopathic in nature.

Management

All patients presenting with suspected papilledema or other manifestations of intracranial hypertension warrant prompt medical evaluation and neurologic testing. Current protocol dictates that patients presumptively diagnosed with papilledema must undergo neuroimaging via computed tomography or, preferably, magnetic resonance imaging within 24 hours. These tests are meant to rule out space-occupying intracranial mass lesions, and therefore should be ordered with contrast media unless otherwise contraindicated. In cases of PTC, neuroimaging typically displays small to normal-sized cerebral ventricles with otherwise normal brain structure. Patients with unremarkable radiographic studies should be subsequently referred for neurosurgical consultation and lumbar puncture. (Lumbar puncture should not be ordered until neuroimaging is found negative for space-occupying mass due to risk for herniation of brainstem through foramen magnum secondary to mass during lumbar puncture.) Additional medical testing includes serologic and hematologic studies.

Therapy for patients with PTC varies, but in most instances initiate systemic medications as a first line treatment. Typically, the drug of choice for the initial management of PTC is oral acetazolamide (Diamox), although other diuretics including chlorthalidone (Hygroton) and furosemide (Lasix) may also be used effectively. Corticosteroid therapy is considered controversial in the management of PTC. While a short-term course of oral or intravenous dexamethasone may be helpful in initially lowering intracranial pressure, it is not considered to be an effective long-term therapy because of the potential for systemic and ocular complications.

For patients in whom conventional medical therapy fails to alleviate the symptoms and prevent pathologic decline, surgical intervention is the only definitive treatment. Cerebrospinal fluid shunting procedures are commonly employed in recalcitrant cases of PTC, but are successful in only 70 to 80 percent of cases. Optic nerve sheath decompression has also been advocated as a method to alleviate chronic disc edema, although this technique fails to directly address the issue of elevated intracranial pressure. It also demonstrates a particularly high failure rate.

Optometric management of patients diagnosed with PTC includes careful and frequent evaluation, including threshold visual fields, acuity measurement, contrast sensitivity, and indirect ophthalmoscopy. Photodocu-mentation of the nerve heads should also be performed.

Clinical Pearls

• PTC is a diagnosis of exclusion.

  
  

• Past literature refers to PTC as benign idiopathic intracranial hypertension, however this condition is far from benign. Patients may suffer intractable headache, severe nausea, intermittent diplopia and permanent vision loss, if they are not properly managed.

  
  

• Although no single causative agent has been identified, it is clear that one very common factor in patients with PTC appears to be obesity in women of childbearing age. Interestingly, significant weight loss in conjunction with conventional therapy leads to complete remission of this disorder in many instances.

  
  

• Patients with PTC should be enrolled in a formal weight-reduction program as a therapeutic measure.

  
  

• While PTC occurs most commonly in females of childbearing age, a number of cases have been encountered in male children.

  
  

Other reports in this section

• Anterior Ischemic Optic Neuropathy
  
• Optic Disc Edema & Papilledema
  
• Cranial Nerve III Palsy
  
• Cranial Nerve IV Palsy
  
• Cranial Nerve VI Palsy
  
• Cranial Nerve VII (Facial Nerve) Palsy
  
• Horner's Syndrome
  
• Internuclear Ophthalmoplegia
  
• Optic Nerve Head Hypoplasia
  
• Optic Pit
  
• Tonic Pupil
  
• Acquired Glaucomatous Changes of the Optic Nerve Head (Pictorial)
  
• Optic Nerve Head Drusen
  
• Demyelinating Optic Neuropathy (Optic Neuritis, Retrobulbar Optic Neuritis)
  
• Amaurosis Fugax and Transient Ischemic Attack
  
• Pseudotumor Cerebri
  
• Pituitary Adenoma

Other links:

Google the National Institute of Neurological Disorders and Stroke

I'll search for others they are on my work computer.

Other than being a nuisance, PTC generally has no complications other than those caused by the co-occurring hypertension (high blood pressure) right?

Is this one of those new diseases that the good people at Pfizer "discovered"?

Sorry for the sass, if this can help Vines I am all for it. This just looks like more fear fuel.

Brenda

For some you may be right, a bothersome condition, however for others like myself, blindness, increased cranial pressure (ie. headaches, backaches, damage to the retnia, optic nerve, just to name a few is a real concern. I'm by no means trying to place fear on anyones plate, just trying to find out if anyone here has dealt with it during the banding surgery. I am wanted to be as informed as everyone or anyone when it comes to the knife. Doctors will need to make the right decissions regarding my health during the surgery, as well as after, to Justify my opinion is not what I am here for. I was asked and I replied to the concerns with the informaiton I have found and have been provided. I can only hope that all is well after the surgery and I will not be having concerns any longer.

Therefore no longer search for discovery in this matter.

I agree with you Maybe just maybe it may help someone.

Looking forward not back...

Thanks so much for posting this MoM. I made an appointment and will see the eye Doc tomorrow (on a Sat no less!). The neuro will take longer to get in to see.

These headaches are getting to the point where I've thought about drilling a hole in my own head to let out the demons!

Hopefully this will, if not be an answer, point in the direction of an answer. I've got a tumor, and this is "false tumor." But the extra pressure could very well be the key.

Ok, thought I'd give you a status report, it seems that the pressure of the tumor has changed my eyesight for the better! This explains why I suddenly had an increase in my vision of 200 points. (old prescription was something like 460/20 and is now like 280/20. She'd never seen anything like that changing so fast, and getting better).

so, I am still wainting on the neurology appointment, but the eye-doc definatly things there is a correlation with the tumor and my headaches...

If we don't ask, we may never get an answer. My thoughts are with you, I know the headaches, (so does my husband) LOL Keep me posted on the progress.

Rule to live by: If you see something you want, ASK FOR IT!

If you get it, then you are ahead, and have something you desire.

If you don't who cares, it wasnt yours in the first place!

Oh no! this a very real disease that I struggle with daily. I have almost lost my vision, my job, my whole world. I now have a shunt in my spine and frequent blinding headaches, neck spasms, and visual problems. But no hypertension. This is an awful, very real disease, that can rob many people of the very life they have known. I PRAY that the lap band helps me with this. I promise, IT'S REAL.