Pseudotumor Cerebri

This one hour presentation on Pseudotumor cerebri is the first in a series of Neuro-Ophthalmology All Star Grand Rounds. The videolecture is accompanied by written material and is intended as a teaching tool for medical residents. Studies in the 1980s calculated the annual incidence of pseudotumor cerebri (PTC) as 0.9/100,000 in the general population, rising to 3.5/100,000 in women 15--44 years and 19.3/100,000 in women ages 20-44 years who are 20% or more above their ideal body weight. With the epidemic of obesity in America, recent studies show that the incidence of PTC has essentially doubled over the past 20 years, with an alarming increase among obese young men.[Garrett, Jacobs] This relatively high frequency ensures that neurologists and ophthalmologists will encounter such patients in their practice and should be familiar with the presentation, diagnosis and management of PTC. Disease/Diagnosis: Pseudotumor cerebri. Clinical notes: Almost all patients (90-95%) with PTC have headache, although occasionally they come to medical attention when papilledema is detected on a routine eye examination. The headache is often daily, retro-ocular and worsened with eye movement.[Giuseffi] Some patients will describe increased severity upon awakening. The headache may also be unilateral, throbbing with nausea, vomiting and photophobia, resembling migraine. Neck and back pain are often prominent features, especially in children. It is not unusual for patients with PTC to have co-existing migraine headaches, making the diagnosis difficult unless other symptoms and signs are present. While headaches are common in PTC, their character is non-specific, and not strongly predictive of the intracranial pressure. Additionally, patients with PTC often have other co-existing headaches, such as migraine or episodic tension-type headache.[Fiedman & Rausch] Chronic daily headaches also raise the possibility of analgesic overuse, which is common in PTC patients, and may worsen their headaches.