Pseudotumor Cerebri Support Group
Pseudotumor cerebri (PTC) is a neurological disorder that is characterized by increased intracranial pressure, in the absence of a tumor or other diseases affecting the brain or its lining. Diagnosis requires brain scans and lumbar puncture. Characteristic symptoms are headache, transient visual obscurations or transient visual loss in one or both eyes usually lasting...
Idiopathic Intracranial Hypertension is a rare neurological disorder that can lead to many tests and medications before the symptoms and the disorder itself are able to be controlled. Intracranial Hypertension is caused by high levels of cerebrospinal fluid within the brain; the exact reason for the high volume has yet to be confirmed. The two reasons for the excess fluid are either the patients body is creating too much spinal fluid or the mechanisms for the reabsorption of the cerebrospinal fluid are not functioning properly. Either process produces the same results which is the high volume of cerebrospinal fluid within the brain causing Intracranial Hypertension.
Intracranial Hypertension can be placed into two categories, either acute or chronic. Acute Intracranial Hypertension can occur due to injury to the head or brain, bleeding of the brain, an aneurysm, or a stroke. Acute Intracranial Hypertension can be reversed by removing a piece of the skull to allow room for the swelling of the brain. Chronic Intracranial Hypertension can also fall under two sub categories, either Idiopathic or Secondary. Idiopathic Intracranial Hypertension occurs with no reason or cause which in turn makes it more difficult to treat, while Secondary Intracranial Hypertension occurs due to an underlying problem within the body. Though all forms of Intracranial Hypertension can be devastating, Idiopathic Intracranial Hypertension can lead to a very long road for the people suffering from it. Due to the fact that so little is known about this disorder it can take many months or even years to get it under control.
People with Idiopathic Intracranial Hypertension will suffer from many affects of this devastating disorder. The most important symptom of this disorder to control is papilledem, which is swelling of the optic discs within the eye. This swelling of the optic disc occurs due to the excess fluid within the brain pushing on the disc. The only way to diagnose this condition is through an ophthalmoscope exam, when the light is shined into the eye the opthmologist can see that the optic disc is swollen. When papilledema is found it is extremely important to reduce the swelling as soon as possible as it will lead to blindness if left untreated. Other symptoms of Idiopathic Intracranial Hypertension include severe headaches and pulsitile tinnitus. Headaches that are due to Idiopathic Intracranial Hypertension are unlike most other headaches, this type of headache does not respond to most over the counter medications. Approximately 90% of people who have chronic IH, report headache, though a minority (less than 10%) have intracranial hypertension and do not experience headache( Intracranial Hypertension Research Foundation[IHRF], 2011). Pulsitile tinnitus usually will accompany the headache but also can appear on its own. Pulsitile tinnitus is best described as a whooshing or marching sound that follows the beat of the hearts pulse. These symptoms all together point to Intracranial Hypertension and will help with diagnosis if the physician is aware of what the disorder is.
When a patient presents these symptoms to a physician the next step is to do testing to rule out any other cause for the symptoms before the diagnosis is made. The first test usually done will be a CT scan of the brain to rule out any masses or abnormalities. A clean CT scan will then lead to a lumbar puncture (spinal tap). A lumbar puncture is done to measure the opening pressures of cerebrospinal fluid, it also allows for the fluid to be tested for any other disorders or diseases the patient may have. During a lumbar puncture a needle is inserted into the lumbar region of the spine and the cerebrospinal fluid pressure can be measured with a manometer. Cerebrospinal fluid is measured in millimeters over water, anything above a reading of 250mm/H2O is considered to be high pressure which will in turn give the diagnosis of Intracranial Hypertension (IHRF, 2011). Most patients with Intracranial Hypertension will have a reading between 300mm/H2O all the way up to 500mm/H2O. After the opening pressure is measured the physician will then begin to drain off as much cerebrospinal fluid as possible to lower the pressure and allow for some relief for the patient. Repeat lumbar punctures may be necessary for some patients if medications are not lowering the fluid levels fast enough and the patient is beginning to lose their vision.
Once diagnosed with Intracranial Hypertension it is extremely important to follow up with a neurologist and begin medications that will bring down the amounts of cerebrospinal fluid within the brain. The most common and first tried medication is usually Diamox. Diamox is a carbonic anhydrase inhibitor and a diuretic; it works buy decreasing the generation of cerebrospinal fluid which leads to less cerebrospinal fluid within the brain. Diamox is not one hundred percent effective for treating Intracranial Hypertension and may sometimes need to have another medication added to it or just need to be pulled from the patients treatment. Along with medications patients with Intracranial Hypertension need to have routine visits to an opthmologist to have visual field testing done and to have their papilledema checked. A visual field test is performed to note any visual loss as it is the primary worry of most physicians, as complete blindness is possible without proper intervention. An Opthmologists will take retinal photos to track the development of the patients papilledema, and note any increase or decrease of the swelling of the optic disc.
When medication has failed to decrease the amount of cerebrospinal fluid within the brain or the swelling of the optic discs surgery may be necessary to save the vision of the patient. One surgery that may be done is optic nerve sheath fenestration, this surgery is done on patients who are losing vision rapidly and have not responded to medication. Optic nerve sheath fenestration a small window-like opening is made in the sheath around the optic nerve, which allows cerebrospinal fluid (CSF) to drain behind the eye and relieves optic nerve swelling (IHRF, 2011). Another more invasive surgery that may be done for patients with Intracranial Hypertension is a shunt. There are a few different types of shunts that can be chosen from but the two most common are a lumboperitoneal shunt (LP shunt) and a ventriculoperitoneal shunt (VP shunt). The purpose of a LP shunt is to redirect cerebrospinal fluid from the lumbar region of the spine into the abdominal cavity. During surgery to place an LP shunt the shunt is placed in-between two lumbar vertebrae, the shunt then continues to wrap around one side of the body under the skin and through the oblique muscles and then into the abdominal cavity in which the cerebrospinal fluid will drain. During a VP shunt an incision is made behind the ear and a hole is drilled in the skull through which the shunt is placed, a catheter is then attached to the shunt and runs down the body under the skin and into the abdominal cavity. VP shunts and LP shunts both serve the same purpose which is to drain the excess cerebrospinal fluid into the abdominal cavity resulting is decreased pressure, decreased swelling of the optic discs, and a decrease in the symptoms suffered due to the disorder.
Intracranial Hypertension is a rare and devastating disorder that can have many physical, emotional, and mental affects on patients who suffer from it. So little is known of the exact mechanisms or causes of this disorder making the reality of diagnosis for patients even harder. Treatment for Intracranial Hypertension has yet to be proven one hundred percent effective, not all medication options work for every patient nor do the surreys. The main cause for concern with Intracranial Hypertension is the possibility of blindness; immediate intervention is needed to avoid any loss of vision. A patient with this disorder will be under the care of a neurologist for the remainder of their life time, and will be on medications for many years. The possibility of remission is possible though rare but there is always a chance of reoccurrence of the disorder. Intracranial Hypertension is a disorder that is listed with the center or rare diseases and disorders and has only one foundation devoted to research for a cure. The diagnosis of Intracranial Hypertension leads to a long road of testing and exams all in hopes of decreasing the amount of cerebrospinal fluid within the brain and providing pain relief for the patient.
Intracranial Hypertension can be placed into two categories, either acute or chronic. Acute Intracranial Hypertension can occur due to injury to the head or brain, bleeding of the brain, an aneurysm, or a stroke. Acute Intracranial Hypertension can be reversed by removing a piece of the skull to allow room for the swelling of the brain. Chronic Intracranial Hypertension can also fall under two sub categories, either Idiopathic or Secondary. Idiopathic Intracranial Hypertension occurs with no reason or cause which in turn makes it more difficult to treat, while Secondary Intracranial Hypertension occurs due to an underlying problem within the body. Though all forms of Intracranial Hypertension can be devastating, Idiopathic Intracranial Hypertension can lead to a very long road for the people suffering from it. Due to the fact that so little is known about this disorder it can take many months or even years to get it under control.
People with Idiopathic Intracranial Hypertension will suffer from many affects of this devastating disorder. The most important symptom of this disorder to control is papilledem, which is swelling of the optic discs within the eye. This swelling of the optic disc occurs due to the excess fluid within the brain pushing on the disc. The only way to diagnose this condition is through an ophthalmoscope exam, when the light is shined into the eye the opthmologist can see that the optic disc is swollen. When papilledema is found it is extremely important to reduce the swelling as soon as possible as it will lead to blindness if left untreated. Other symptoms of Idiopathic Intracranial Hypertension include severe headaches and pulsitile tinnitus. Headaches that are due to Idiopathic Intracranial Hypertension are unlike most other headaches, this type of headache does not respond to most over the counter medications. Approximately 90% of people who have chronic IH, report headache, though a minority (less than 10%) have intracranial hypertension and do not experience headache( Intracranial Hypertension Research Foundation[IHRF], 2011). Pulsitile tinnitus usually will accompany the headache but also can appear on its own. Pulsitile tinnitus is best described as a whooshing or marching sound that follows the beat of the hearts pulse. These symptoms all together point to Intracranial Hypertension and will help with diagnosis if the physician is aware of what the disorder is.
When a patient presents these symptoms to a physician the next step is to do testing to rule out any other cause for the symptoms before the diagnosis is made. The first test usually done will be a CT scan of the brain to rule out any masses or abnormalities. A clean CT scan will then lead to a lumbar puncture (spinal tap). A lumbar puncture is done to measure the opening pressures of cerebrospinal fluid, it also allows for the fluid to be tested for any other disorders or diseases the patient may have. During a lumbar puncture a needle is inserted into the lumbar region of the spine and the cerebrospinal fluid pressure can be measured with a manometer. Cerebrospinal fluid is measured in millimeters over water, anything above a reading of 250mm/H2O is considered to be high pressure which will in turn give the diagnosis of Intracranial Hypertension (IHRF, 2011). Most patients with Intracranial Hypertension will have a reading between 300mm/H2O all the way up to 500mm/H2O. After the opening pressure is measured the physician will then begin to drain off as much cerebrospinal fluid as possible to lower the pressure and allow for some relief for the patient. Repeat lumbar punctures may be necessary for some patients if medications are not lowering the fluid levels fast enough and the patient is beginning to lose their vision.
Once diagnosed with Intracranial Hypertension it is extremely important to follow up with a neurologist and begin medications that will bring down the amounts of cerebrospinal fluid within the brain. The most common and first tried medication is usually Diamox. Diamox is a carbonic anhydrase inhibitor and a diuretic; it works buy decreasing the generation of cerebrospinal fluid which leads to less cerebrospinal fluid within the brain. Diamox is not one hundred percent effective for treating Intracranial Hypertension and may sometimes need to have another medication added to it or just need to be pulled from the patients treatment. Along with medications patients with Intracranial Hypertension need to have routine visits to an opthmologist to have visual field testing done and to have their papilledema checked. A visual field test is performed to note any visual loss as it is the primary worry of most physicians, as complete blindness is possible without proper intervention. An Opthmologists will take retinal photos to track the development of the patients papilledema, and note any increase or decrease of the swelling of the optic disc.
When medication has failed to decrease the amount of cerebrospinal fluid within the brain or the swelling of the optic discs surgery may be necessary to save the vision of the patient. One surgery that may be done is optic nerve sheath fenestration, this surgery is done on patients who are losing vision rapidly and have not responded to medication. Optic nerve sheath fenestration a small window-like opening is made in the sheath around the optic nerve, which allows cerebrospinal fluid (CSF) to drain behind the eye and relieves optic nerve swelling (IHRF, 2011). Another more invasive surgery that may be done for patients with Intracranial Hypertension is a shunt. There are a few different types of shunts that can be chosen from but the two most common are a lumboperitoneal shunt (LP shunt) and a ventriculoperitoneal shunt (VP shunt). The purpose of a LP shunt is to redirect cerebrospinal fluid from the lumbar region of the spine into the abdominal cavity. During surgery to place an LP shunt the shunt is placed in-between two lumbar vertebrae, the shunt then continues to wrap around one side of the body under the skin and through the oblique muscles and then into the abdominal cavity in which the cerebrospinal fluid will drain. During a VP shunt an incision is made behind the ear and a hole is drilled in the skull through which the shunt is placed, a catheter is then attached to the shunt and runs down the body under the skin and into the abdominal cavity. VP shunts and LP shunts both serve the same purpose which is to drain the excess cerebrospinal fluid into the abdominal cavity resulting is decreased pressure, decreased swelling of the optic discs, and a decrease in the symptoms suffered due to the disorder.
Intracranial Hypertension is a rare and devastating disorder that can have many physical, emotional, and mental affects on patients who suffer from it. So little is known of the exact mechanisms or causes of this disorder making the reality of diagnosis for patients even harder. Treatment for Intracranial Hypertension has yet to be proven one hundred percent effective, not all medication options work for every patient nor do the surreys. The main cause for concern with Intracranial Hypertension is the possibility of blindness; immediate intervention is needed to avoid any loss of vision. A patient with this disorder will be under the care of a neurologist for the remainder of their life time, and will be on medications for many years. The possibility of remission is possible though rare but there is always a chance of reoccurrence of the disorder. Intracranial Hypertension is a disorder that is listed with the center or rare diseases and disorders and has only one foundation devoted to research for a cure. The diagnosis of Intracranial Hypertension leads to a long road of testing and exams all in hopes of decreasing the amount of cerebrospinal fluid within the brain and providing pain relief for the patient.
I once did this for a boyfriend on his thesis
A few comments;
Paragraph 2 Line 5.The exam is called The Slit Lamp test.
Paragraph 3 . Line 2. Papilloedema.
Paragraph 3. line 3.You didn't mention an MRI, and its possible finding.
Paragraph 3. line 13.You have talked about lps as a therapeutic aid, do you think it should be mentioned that this idea is now falling out of favor as the risks are too high , for, infection, little relief and the damage done by repeated lps with scar tissue and herniation of the brain?
Paragraph 3. Line 34.Maybe mention that while ONSF may save the eye sight, it does not elevate the other symptoms.
Paragraph 3 . Line 49. Should you include financial and family problems as well?
Paragraph 3. Line 52. Surgeries misspelt.
You didn't include the "weight" issue. Much as we all disagree with it, with out mentioning it, you cant argue it.
Long term effects?
I think you have done a terrific paper April and I hope you are not insulted by my few ideas. Its so hard to remove your self from this, emotionally , which I think you have done but may be that's where my thoughts come form.
The very best with your paper! Cath.