Walsh & Hoyt: Pseudotumor Cerebri: Monitoring

Since the major morbidities of PTC are visual loss and headaches, a team approach to management is necessary. The tempo of visual loss in patients with PTC may be rapid or slowly progressive. Most visual defects associated with papilledema are reversible if ICP is lowered before there is severe visual loss or optic nerve ischemia. Thus, it is imperative that patients be monitored by an ophthalmologist who can assess the best corrected visual acuity, optic nerve functions, visual fields by quantitative static or kinetic perimetry, and the severity of papilledema. Patients with papilledema most often develop progressive loss of visual function in a manner similar to that which occurs in chronic open angle glaucoma. Loss of central vision is usually a late phenomenon, whereas visual field defects, usually arcuate scotomas and nasal steps, are an early finding.