Diseases & Conditions

Benign Intracranial Hypertension - Pseudotumor Cerebri


Overview, Causes, & Risk Factors

Pseudotumor cerebri is a condition that causes increased intracranial pressure, or pressure within the brain, for unknown reasons. Symptoms are produced that are sometimes mistaken for a brain tumor.

What is going on in the body?

This condition is not fully understood. It is more common in women who are between the ages of 20 and 50, who are overweight, and who have irregular menstrual periods. An eye exam shows swelling of the optic nerves in the retina, known as papilledema, which indicates increased intracranial pressure. The symptoms mimic those of a brain tumor.

What are the causes and risks of the condition?

There is no clear cause of this disorder. There is a possibility that tetracycline, oral contraceptives, and medications that contain steroids may cause the condition. However, they do not always lead to this disorder.

Infertility may result from irregular menstrual periods. Optic nerve swelling may lead to blindness if the intracranial pressure is not relieved.


Symptoms & Signs

What are the signs and symptoms of the condition?

Early symptoms include:

  • headache
  • nausea and vomiting
  • weight gain
  • irregular menstrual cycles. Sometimes menstruation does not occur at all.
  • Later symptoms include a loss of vision.


    Diagnosis & Tests

    How is the condition diagnosed?

    Imaging studies such as cranial CT scans or cranial MRIs are done to rule out a brain tumor. A spinal tap, or withdrawal of cerebrospinal fluid using a thin needle, will reveal increased intracranial pressure. If enough fluid is removed, the headache will often be relieved, further confirming the diagnosis.


    Prevention & Expectations

    What can be done to prevent the condition?

    Prevention lies in early diagnosis and treatment. Weight control is recommended. Regular eye examinations are recommended for early diagnosis of increased intracranial pressure and loss of vision.

    What are the long-term effects of the condition?

    If not properly treated, the person may continue to experience symptoms. These include headaches and irregular menstrual cycles, possibly leading to infertility. Loss of vision may occur, which may be permanent.

    What are the risks to others?

    There are no risks to others.


    Treatment & Monitoring

    What are the treatments for the condition?

    The condition may be treated either medically or surgically. Sometimes a combination of the two may be necessary. If the problem is caused by a medication such as oral contraceptives, the medication will be stopped. Other medical treatments include:

  • diuretics, or "water pills", to remove excess fluid from the body
  • pain medications as needed
  • spinal tap to remove excess fluid from the ventricles of the brain
  • weight control
  • Surgical treatment commonly involves placing a ventriculoperitoneal shunt in the brain to drain the excess cerebrospinal fluid into the abdominal cavity. There are other less common surgical treatments that can be done to relieve pressure in the brain.

    What are the side effects of the treatments?

    Pain medications and diuretics may cause allergic reactions, stomach upset, and salt imbalance. Surgery carries a risk of bleeding, infection, and allergic reaction to the anesthesia.

    What happens after treatment for the condition?

    A ventriculoperitoneal shunt may malfunction and need to be replaced. The condition may recur if the pressure within the brain increases again.

    How is the condition monitored?

    The disease is monitored through regular eye examinations by a specialist. Weight control and menstrual cycles are monitored on a regular basis through physical examinations. Any new or worsening symptoms should be reported to the healthcare provider.


    Attribution

    Author:James Warson, MD
    Date Written:
    Editor:Planko, Christa, MA
    Edit Date:05/03/00
    Reviewer:Donna Lester, RN, PHN, BSN, CCM
    Date Reviewed:06/01/01

    Sources

    The Merck Manual, 17th Edition; Current Medical Diagnosis & Treatment 2000.