Advertisement

Pseudotumour Cerebri-neurosurgical Considerations

  • T. Lundar
  • H. Nornes
Conference paper
Part of the Acta Neurochirurgica book series (NEUROCHIRURGICA, volume 51)

Summary

Pseudotumour was diagnosed in six patients aged 3-38 years during an 8 years period. The diagnosis was based on headache, papilloedema, normal CT scan and cerebrospinal fluid (CSF) composition. Additional clinical symptoms were nausea, VIth nerve palsy, ataxia, blurred vision and frank visual reduction over time. Sagittal sinus thrombosis was ruled out by angiography or magnetic resonance imaging.

In five of the six patients lumbar steady state infusion tests were performed to evaluate intracranial hydrodynamics and CSF resorbtion. All patients demonstrated a markedly increased opening pressure (range 13 to 48 mm Hg). CSF outflow resistance ranged from upper normal to pathologically increased levels (8-19 mm Hg/ml/ min). Combined epidural intracranial pressure/middle cerebral artery blood velocity monitoring in 3 patients revealed a great number of B waves and a labile cerebral vasomotor state.

Pharmacological treatment was tried with digitoxin, acetazolamide, furosemide and/or corticosteroids. Two patients did well on long-term treatment with digitoxin and furosemide, respectively. In the other four patients the clinical development was unsatisfactory on medical treatment alone. They were subsequently operated with implantation of a lumboperitoneal, cisternoatrial or cisternoperitoneal shunt. Shunting rapidly reversed clinical signs and symptoms, except for a partial persistent visual loss in an 18 years old boy who had experienced symptoms for 3 years resistant to pharmacological treatment.

Keywords

Benign Intracranial Hypertension Visual Reduction Sagittal Sinus Thrombosis Pseudotumour Cerebri Middle Cerebral Artery Flow 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Ark GD van der, Kempe LG, Smith DR (1971) Pseudotumour cerebri treated with lumbar-peritoneal shunt. JAMA 217: 1832–1834CrossRefGoogle Scholar
  2. 2.
    Beatty RA (1982) Cervical-peritoneal shunt in the treatment of pseudotumour cerebri. J Neurosurg 57: 853–855PubMedCrossRefGoogle Scholar
  3. 3.
    Corbett JJ, Savino PJ, Thompson HS, Kansu T, Schatz NJ, Orr LS et al (1982) Visual loss in pseudotumour cerebri. Follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss. Arch Neurol 39: 461–474PubMedCrossRefGoogle Scholar
  4. 4.
    Gerris F, Soelberg-Sorensen P, Vorstrup S, Paulson OB (1985) Intracranial pressure. Conductance to cerebrospinal fluid outflow, and cerebral blood flow in patients with benign intracranial hypertension. Ann Neurol 17: 158–162Google Scholar
  5. 5.
    Hoffman H (1986) How is pseudotumour cerebri diagnosed? Arch Neurol 43: 167–168PubMedCrossRefGoogle Scholar
  6. 6.
    Kidron D, Pomeranz S (1989) Malignant pseudotumour cerebri. Report of two cases. J Neurosurg 71: 443–445Google Scholar
  7. 7.
    Marmarou A, Shulman K, Rosende RM (1978) A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurg 48: 332–344PubMedCrossRefGoogle Scholar
  8. 8.
    Sklar F (1985) Pseudotumour cerebri. In: Wilkins RH, Rengachary SS (eds) Neurosurgery. McGraw-Hill, New York, pp 350–353Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • T. Lundar
    • 1
  • H. Nornes
    • 1
  1. 1.Department of NeurosurgeryRikshospitaletOsloNorway

Personalised recommendations