A 33-year-old woman complains of generalized, throbbing headache that is worse in the morning and with coughing. She occasionally feels dizzy and nauseated. Examination is significant only for obesity and bilateral papilledema. CT scan of the head is nominal. At lumbar puncture the opening pressure is 220 mm H2O; CSF is clear, with protein of 12 mg/100 mL (normal is 15 to 45), glucose of 68 mg/100 mL (normal is 45 to 80), an d no cells are seen. The most likely diagnosis is:
Pseudotumor cerebri is a disorder of increased intracranial pressure that has no obvious cause. The typical patient is an obese young woman who complains of headache and is found to have papilledema. Slight decrease in visual fields and enlargement of blind spots may also be observed. Neurologic examination is otherwise normal, and the patient appears to be healthy. CSF is under increased pressure and may have slightly low protein concentration but is otherwise normal. CT scan, aeriogram, and other x-ray studies are usually normal. The most serious complication is severe visual loss, which occurs in about 10% of affected persons. Treatment with coicosteroids and serial lumbar punctures usually leads to resolution in weeks to months. Ref: Ropper A.H., Samuels M.A. (2009). Chapter 30. Disturbances of Cerebrospinal Fluid and Its Circulation, Including Hydrocephalus, Pseudotumor Cerebri, and Low-Pressure Syndromes. In A.H. Ropper, M.A. Samuels (Eds), Adams and Victor's Principles of Neurology, 9e.
Migraine headache
Multiple Sclerosis
Malignant carcinomatosis
Pseudotumor cerebri