PSEUDOTUMOR CEREBRI AND ITS MEDICAL-TREATMENT

Pseudotumor cerebri is an idiopathic disorder characterized by papille dema and elevated intracranial pressure without a mass lesion. Most pa tients are female and young and are either over-weight or have a histo ry of recent weight gain. Other disease states, such as systemic lupus erythematosus, and drugs, such as tetracycline, have also been associ ated with the development of pseudotumor cerebri. The mechanism is unc lear, but is likely related to decreased cerebrospinal fluid (CSF) res orption. Almost all patients have headache, but the greatest morbidity of the disorder is visual loss related to optic disc swelling. Common radiographic findings in pseudotumor cerebri include an empty sella, dilation of the optic nerve sheaths and elevation of the optic disc. T he CSF, aside from elevated opening pressure, is normal without eviden ce of infection or inflammation. Treatment of patients with no or mild to moderate visual loss is primarily medical, with acetazolamide as t he first-line agent. Acetazolamide decreases CSF production. Furosemid e and corticosteroids are secondary choices. Optic nerve surgery is re served for patients with severe visual loss or progression in visual d eficits despite medical management. (C) 1998 Prous Science. All rights reserved.