A 30 years-old female presents with headache and transient obscurations of her vision. On examination, no focal neurological deficit was seen. Which one of the following would you sta her on?
Above image shows a paial empty sella which is seen in raised intracranial tension. The pseudotumor cerebri syndrome (PTCS) is a perplexing syndrome of increased intracranial pressure without a space-occupying lesion. annual incidence of pseudotumor cerebri syndrome. Symptoms include headache, transient visual obscurations, pulsatile tinnitus, visual loss, diplopia. Signs include 6th nerve palsy and papilledema. Figure: Flattening of the posterior sclera and protrusions of the optic nerve heads(This is the radiographic correlate with papilledema) In addition, for the diagnosis to be made brain imaging must show no structural causes of raised ICP, and lumbar puncture CSF opening pressure >25 cm H2O in relaxed adults and >28 cm H2O in a (sedated) child with normal CSF analysis. In the absence of papilledema or 6th nerve palsy, possible diagnosis of PTCS is suggested by MRI showing at least three of: empty sella, flattening of the posterior aspect of the globe, distension of perioptic subarachnoid space ( 1/4 /- touous optic nerve), transverse venous sinus stenosis. The main goal of treatment is preservation of vision. As such, patients presenting with deteriorating vision require more aggressive initial management. General management strategies include weight loss (including bariatric surgery in some cases), salt restriction. Treatment options include acetazolamide, topiramate (headache and causes weight loss), ventriculoperitoneal or lumboperitoneal CSF shunting, optic nerve sheath fenestration and in some cases venous sinus stenting.
Acetazolamide
Bromocriptine
Coicosteroids
Furosemide
Neuroradiology