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Treatments and drugs
By Mayo Clinic staffPseudotumor cerebri treatment typically begins with medications to control the symptoms. Weight loss is recommended for obese individuals. If your vision worsens, surgery to reduce the pressure around your optic nerve or to decrease the intracranial pressure may be necessary.
Medications
- Glaucoma drugs. One of the first drugs usually tried is acetazolamide (Diamox), a glaucoma drug that reduces the production of cerebrospinal fluid by at least 50 percent. Possible side effects include stomach upset; fatigue; tingling of fingers, toes and mouth; and kidney stones.
- Diuretics. If acetazolamide alone isn't effective, it's sometimes combined with furosemide, a potent diuretic that reduces fluid retention by increasing urine output.
- Migraine medications. Medications typically prescribed to relieve migraines can sometimes ease the severe headaches that often accompany pseudotumor cerebri.
Surgery
- Optic nerve sheath fenestration. This procedure cuts a window into the membrane that surrounds the optic nerve. This allows excess cerebrospinal fluid to escape. Vision stabilizes or improves in more than 85 percent of cases. Most people who have this procedure done on one eye notice a benefit for both eyes. However, this surgery isn't always successful and may even increase vision problems.
- Spinal fluid shunt. Another type of surgery inserts a long, thin tube — called a shunt — into your brain or lower spine to help drain away excess cerebrospinal fluid. The tubing is burrowed under your skin to your abdomen, where the shunt discharges the excess fluid. Symptoms improve for more than 80 percent of the people who undergo this procedure. But shunts can become clogged and often require additional surgeries to keep them working properly. Complications can include low-pressure headaches and infections.
References
- NINDS pseudotumor cerebri information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/pseudotumorcerebri/pseudotumorcerebri.htm. Accessed Sept. 22, 2008.
- Stebbins GT, et al. Headache. In Goetz CG. Textbook of Clinical Neurology. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/105339567-3/0/1488/451.html?tocnode=53805161&fromURL=451.html#4-u1.0-B978-1-4160-3618-0..10053-0--s0290_4630. Accessed Sept. 22, 2008.
- Kwiatkowski T, et al. Headache. In: Marx JA. Rosen's Emergency Medicine: Concepts and Clinical Practice. 3rd ed. Philadelphia, Pa.: Mosby Elsevier; 2006. http://www.mdconsult.com/das/book/body/105359053-3/750608143/1365/305.html#4-u1.0-B0-323-02845-4..50106-2--cesec45_5292. Accessed Sept. 22, 2008.
- Chapman K, et al. Idiopathic intracranial hypertension (pseudotumor cerebri) in children. http://www.uptodate.com/home/index.html. Accessed Sept. 22, 2008.
- What is IH? Intracranial Hypertension Research Foundation. http://www.ihrfoundation.org/intracranial/hypertension/info/C16. Accessed Sept. 23, 2008.
- Neurological diagnostic tests and procedures. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/misc/diagnostic_tests.htm. Accessed Sept. 23, 2008.
- Daniels AB, et al. Profiles of obesity, weight gain and quality of life in idiopathic intracranial hypertension (pseudotumor cerebri). American Journal of Ophthalmology. 2007;143(4):635-41.
