Pseudotumor Cerebri Treatment

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Pseudotumor cerebri, also called idiopathic intracranial hypertension (IIH), is a condition in which the pressure inside your skull is too high. This pressure can cause symptoms similar to those of a brain tumor. Most people completely recover with treatment.

Treating Pseudotumor Cerebri at UVA Health

At UVA Health, we have experts we specialize in treating pseudotumor cerebri and other benign brain conditions. Treatment focuses on:

  • Symptom relief
  • Reducing pressure inside your skull
  • Preserving your vision

We have many different healthcare providers, including neurologists; neurosurgeons; ear, nose and throat specialists; and eye specialists, contributing to your diagnosis and care. We’ve had particular success treating certain difficult cases with stenting, a minimally-invasive procedure that widens veins to relieve pressure in the head.

Relief With Time & Lifestyle Changes

Sometimes, this condition goes away without any treatment.

We’ve also found that, if you’re overweight, losing weight and maintaining a low-sodium diet may help reduce pressure inside your skull. In some cases, you might consider weight-loss surgery as an option.

Medication for Pain & Pressure

Treatment usually starts with medications to relieve pain. You’ll also likely need medications that help reduce pressure in your skull, such as:

  • Diuretics (decrease the general amount of body fluids)
  • Acetazolamide (decreases the production of cerebrospinal fluid)
  • Steroids (needed when vision loss happens quickly)

Other treatment options aim to reduce major symptoms, including headaches and vision loss.

Surgery to Relieve Symptoms

If medications aren’t enough to relieve your pseudotumor cerebri, you may need surgery. Options include:

  • Shunts (drainage tubes that move cerebrospinal fluid away from the brain to be absorbed elsewhere in the body)
  • Stents (open up and widen veins in the head)
  • Optic nerve surgery (to relieve pressure on the nerve and help preserve vision)

Do You Have Pseudotumor Cerebri?

Symptoms may include:

  • Headaches (sometimes daily)
  • Blurred, doubled or loss of vision (from optic nerve inflammation)
  • Nausea
  • Dizziness
  • Hearing loss or tinnitus (ringing in the ears)
  • Neck stiffness

The symptoms may get worse with exercise. Over 90% of patients have severe headaches. Vision loss may happen quickly and can be permanent.

Pseudotumor Cerebri Diagnosis

We don’t know what causes pseudotumor cerebri. It tends to occur in patients in their 20s-50s, in women more than men and it’s often associated with obesity. If you have cerebrospinal fluid rhinorrhea, cerebrospinal fluid otorrhea, or nasal meningoceles/encephaloceles, you may also have pseudotumor cerebri.

You’ll likely need multiple tests to rule out other causes of your symptoms (such as meningitis, obstructive hydrocephalus, tumors and blockage of the veins that drain blood away from the brain). 

Tests may include:

  • Eye exam to test for vision loss and papilledema (swelling of the optic nerve)
  • Hearing test to look for any other causes of tinnitus
  • Imaging to review the condition of the brain, rule out a tumor or other causes, and examine the size of the veins in the head
  • Spinal tap (lumbar puncture) to measure the brain and spinal fluid pressure and check for bacteria or viruses