Health Encyclopedia

Pseudotumor cerebri

Definition

Pseudotumor cerebri is a process affecting the brain that appears to be -- but is not -- a tumor. It is often reversible.

Alternative Names

Idiopathic intracranial hypertension; Benign intracranial hypertension

Causes, incidence, and risk factors

The cause for the condition is unknown.

Certain medicines can increase your risk for this condition. These medicines include:

Non-steroidal anti-inflammatory drugs (NSAIDs)
Tetracycline
Nitrofurantoin
Isotretinoin
Minocycline
Tamoxifen
Nalidixic acid
Lithium
Steroids (starting or stopping them)

The following factors also increase your risk:

Obesity
Vitamin A (too much or too little)
Cushing’s disease
Hypoparathyroidism
Hypothyroidism
Chronic kidney failure
Anemia

The condition occurs more frequently in women than men, particularly in premenopausal obese women. It is rare in infants.

Symptoms

The major symptom is increased pressure within the skull (increased intracranial pressure). There is no evidence of tumor, infection, blocked drainage of the fluid surrounding the brain, or any other cause.

Symptoms include:

Headache
Buzzing sound in the ears (tinnitus)
Dizziness
Nausea
Double vision (diplopia)
Partial or permanent loss of vision. Patients often complain of blurred vision.

Symptoms may get worse during physical activity, especially when tightening the stomach muscles.

Signs and tests

The doctor will perform a physical exam. Signs of this condition include:

Swelling of a small area in the back of the eye (papilledema)
Increased head size
Bulging anterior fontanelle in babies whose cranial sutures are not yet closed

Despite the increased pressure in the skull, there is no change in alertness.

Tests that may be done include:

CT Scan
MRI
Lumbar puncture (spinal tap)
Eye exam, including formal visual field testing

The diagnosis is made when other health conditions are ruled out. Several conditions may cause increased intracranial pressure, including venous sinus thrombosis, hydrocephalus, and an intracranial mass (such as a tumor).

Treatment

Treatment must be directed at the specific cause of the pseudotumor.

A lumbar puncture can help relieve pressure within the brain and prevent vision problems.

Other treatments may include:

Fluid or salt restrictions
Medications such as corticosteroids, glycerol, acetazolamide, and furosemide
Shunting procedures to relieve pressure due to spinal fluid retention
Surgery to relieve pressure on the optic nerve
Weight loss

The patient will need their vision closely monitored, since there is potential for progressive and sometimes permanent visual loss. Follow-up MRI or CT scans may be done to rule out hidden cancer.

Expectations (prognosis)

Sometimes the condition disappears on its own within 6 months. About 10-20% of persons have their symptoms return. A small number of patients have symptoms that slowly get worse and lead to blindness.

Complications

Vision loss is a serious complication of this condition.

Calling your health care provider

Call your health care provider if you or your child experience the symptoms listed above.

References

Jonnalagadda J. Lithium, minocycline, and pseudotumor cerebri. J Am Acad Child Adolesc Psychiatry. March 1, 2005; 44(3): 209.

Behrman RE. Nelson Textbook of Pediatrics. 17th ed. Philadelphia, Pa: WB Saunders; 2004; 2048-2049.

Review Date:1/17/2008
Reviewed By:A.D.A.M. Editorial Team: David Zieve, MD, MHA, Greg Juhn, MTPW, David R. Eltz, Kelli A. Stacy, ELS. Previously reviewed by Daniel Kantor, MD, Director of the Comprehensive MS Center, Neuroscience Institute, University of Florida Health Science Center, Jacksonville, FL. Review provided by VeriMed Healthcare Network (3/5/2007).

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