🎯 Pathology

• also known as pseudotumor cerebri

• it is a disorder that increases the pressure within the intracranial cavity

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💡 Causes

• accumulation of cerebrospinal fluid (CSF) either due to increased production and/or decreased absorption of CSF

• the exact cause is unknown, although associated risk factors are as follow:

  • young overweight women

  • pregnancy

  • drugs (remember ‘LOST vitamin A’)

    • Lithium

    • combined Oral contraceptive pill

    • Steroids

    • Tetracyclines (e.g. doxycycline, minocycline)

    • vitamin A and retinoids (e.g. isotretinoin)

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🩺 Clinical features

• headache (worse in the morning and with Valsalva manoeuvre)

• nausea

• vomiting

• visual changes

  • unilateral or bilateral horizontal double vision (due to involvement of CN VI)

  • papilloedema may be seen on fundoscopy

  • unilateral or bilateral esotropia (due to involvement of CN VI)

  • vision loss

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🕵️‍♂️ Investigations

• neuroimaging

  • CT

  • MRI with venography is best (helps rule out secondary causes of intracranial hypertension such as transverse sinus stenosis)

• fundoscopy to investigate for papilloedema

• lumbar puncture

  • neuroimaging must be done first to rule out a intracranial space-occupying lesion (as it may precipitate coning which results when the brainstem is compressed, a neurosurgical emergency)

  • opening pressure greater than 25cm H2O in adults is suggestive

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💆‍♂️ Management

• weight loss

• avoid medications that precipitating medications

• a lumbar puncture can be therapeutic as it can relieve symptoms

• medications considered that lower intracranial pressure

  • carbonic anhydrase inhibitors (e.g. acetazolamide)

  • topiramate as it can inhibit carbonic anhydrase

• surgery (for refractory cases to medical treatment)

  • optic nerve sheath defenestration

  • ventriculoperitoneal shunt