Diagnosis

To diagnose your condition, your doctor will review your symptoms and medical history, conduct a physical examination, and order several tests.

Eye exams

A doctor trained in eye conditions (ophthalmologist) may conduct an eye examination.

If pseudotumor cerebri is suspected, your eye doctor will look for a distinctive type of swelling affecting the optic nerve, called papilledema, in the back of your eye.

You'll also undergo a visual fields test to see if there are any blind spots in your vision besides your so-called normal blind spot in each eye where the optic nerve enters the retina.

Brain imaging

Your doctor may order an MRI or CT scan. These tests can rule out other problems that can cause similar symptoms, such as brain tumors and blood clots.

Spinal tap (lumbar puncture)

Your doctor may order a lumbar puncture to measure the pressure inside your skull, as well as your glucose and protein levels.

In this test, a specialist inserts a needle between two vertebrae in your lower back and removes a small amount of cerebrospinal fluid for testing in the laboratory.

Treatment

The goal of pseudotumor cerebri treatment is to improve your symptoms and keep your eyesight from worsening. Depending on your condition, your doctor may prescribe medications or recommend surgery to control your symptoms.

Medications

  • Glaucoma drugs. One of the first drugs usually tried is acetazolamide (Diamox), a glaucoma drug. This medication may reduce the production of cerebrospinal fluid. Also, it has been shown to improve symptoms in 47 to 67 percent of people.

    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 (Lasix), a potent diuretic that reduces fluid retention by increasing urine output.
  • Migraine medications. Medications usually prescribed to relieve migraines can sometimes ease the severe headaches that often accompany pseudotumor cerebri.

If your vision worsens, surgery to reduce the pressure around your optic nerve or to decrease the intracranial pressure may be necessary.

Surgery

  • Optic nerve sheath fenestration. In this procedure, a surgeon cuts a window into the membrane that surrounds the optic nerve. This allows excess cerebrospinal fluid to escape.

    Vision stabilizes or improves in most 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. In another type of surgery, your doctor inserts a long, thin tube (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 may improve for some people who undergo this procedure.

    However, shunts can become clogged and often require additional surgeries to keep them working properly. Complications can include low-pressure headaches and infections.

    This procedure is generally only a treatment option if other treatments haven't relieved your condition.

If you're obese, your doctor will recommend weight loss. You may work with a dietitian to help with your weight-loss goals. Losing weight may improve your symptoms. Some people who are morbidly obese may benefit from weight-loss programs or gastric surgery to lose weight.

Once you've had pseudotumor cerebri, you should have your vision checked regularly.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Obesity dramatically increases a young woman's risk of pseudotumor cerebri. In fact, even in women who aren't obese a moderate amount of weight gain may increase the risk.

Losing extra pounds and maintaining a healthy weight may help reduce your chances of developing this potentially sight-stealing disorder.

Preparing for your appointment

Though you might first discuss your symptoms with your family doctor, he or she may refer you to a doctor trained in brain and nervous system conditions (neurologist) or eye conditions (ophthalmologist) for further evaluation.

To get the most from your appointment, it's a good idea to prepare. Here's some information to help you.

What you can do

  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you're taking.
  • Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all the information you get during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.

Preparing a list of questions to ask your doctor will help you make the most of your time together. For pseudotumor cerebri, some questions to ask your doctor include:

  • What is likely causing my symptoms or condition?
  • Other than the most likely cause, what are other possible causes for my symptoms or condition?
  • What kinds of tests do I need?
  • Is my condition likely temporary or chronic?
  • What is the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • Would losing weight help my condition?
  • I have these other health conditions. How can I best manage them together?
  • Are there any restrictions I need to follow?
  • Should I see a specialist?
  • Is there a generic alternative to the medicine you're prescribing?
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend?

Don't hesitate to ask any other questions that arise during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, including:

  • When did you begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
Aug. 10, 2017
References
  1. Markey KA, et al. Understanding idiopathic intracranial hypertension: Mechanisms, management, and future directions. Lancet Neurology. 2016;15:78.
  2. Ferri FF. Idiopathic intracranial hypertension . In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Mosby Elsevier; 2017. https://www.clinicalkey.com. Accessed Aug. 8, 2016.
  3. Idiopathic intracranial hypertension (pseudotumor cerebri). American Association for Pediatric Ophthalmology and Strabismus. https://www.aapos.org/terms/conditions/59. Accessed Aug. 8, 2016.
  4. Lee AG, et al. Idiopathic intracranial hypertension (pseudotumor cerebri): Epidemiology and pathogenesis. http://www.uptodate.com/home. Accessed Aug. 8, 2016.
  5. NINDS pseudotumor cerebri information page. National Institute of Neurological Disorders and Stroke. http://www.ninds.nih.gov/disorders/pseudotumorcerebri/pseudotumorcerebri.htm. Accessed Aug. 8, 2016.
  6. Lee AG, et al. Idiopathic intracranial hypertension (pseudotumor cerebri): Clinical features and diagnosis. http://www.uptodate.com/home. Accessed Aug. 8, 2016.
  7. Lee AG, et al. Idiopathic intracranial hypertension (pseudotumor cerebri): Prognosis and treatment. http://www.uptodate.com/home. Accessed Aug. 8, 2016.