Department: Ask the Experts: Your Questions Answered
Q I have intracranial hypertension. Have there been any recent advances in diagnosis and treatment?
A Intracranial hypertension (also known as pseudotumor cerebri, benign intracranial hypertension, or idiopathic intracranial hypertension) is a disorder caused by an increase in the pressure of the cerebrospinal fluid in the brain. The most common symptoms are headache and transient visual problems.
The cause is unknown; and while intracranial hypertension is not fatal, if left untreated it can lead to permanent loss of vision. Diagnosis begins with a brain MRI or MR angiogram to rule out a brain mass or other brain disorder causing increased pressure. A lumbar puncture (spinal tap) is performed to measure the cerebrospinal-fluid pressure, and if it is elevated, treatment is started.
Standard treatment includes weight loss, repeated lumbar punctures, salt and fluid restriction, and diuretic therapy. Most of the time medical treatment works, but when it fails, surgeries may be recommended: either optic nerve sheath decompression (opening the covering around the optic nerve), or a shunt from the low back or head to the abdomen in order to drain the cerebrospinal fluid. In general the procedures are safe. Additionally, a new investigational surgical treatment has been tried that places a stent in the cerebral vein to relieve narrowing, but the safety and efficacy have not yet been determined.