Pseudotumor cerebri history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

History and Symptoms

History

  • The important points in the history of a patient suspected for pseudotumor cerebri are:
Age and gender
  • Most of the IIH cases happen in women in child bearing age[1], but it can also happens in children and old adult with male gender. In prepubertal age the gender is not an important risk factor and in old patients the percent of affected males was higher than females.[2][3]
Obesity
Positive family history[5]
Medications
  • growth hormones: Development of IIH in result of GH therapy mostly happens in one year of medication initiation, but it can also develop after several years of treatment. with stopping the use of GH, symptoms of IIH will improve.[6][7]
Systemic illness
symptoms
  • Headache (84 to 92 percent):
  • visual symptoms(68 to 72 percent):
  • Intracranial noises (pulsatile tinnitus) (52 to 60 percent):
  • Photopsia (48 to 54 percent):
  • Back pain (53 percent):
  • Retrobulbar pain (44 percent):
  • Diplopia (18 to 38 percent):
  • Sustained visual loss (26 to 32 percent)[20]

Symptoms

Common Symptoms

  • Common symptoms of pseudotumor cerebri include:

Headache (84 to 92 percent):

visual symptoms(68 to 72 percent):

  • Transient visual obscuration can be rarely present in one group and frequently in another one. This symptom is unilateral or bilateral and can be provoked by change in position like standing up or bending over and also with valsalva maneuver, bright light and eye movement.[1][20]

Intracranial noises (pulsatile tinnitus) (52 to 60 percent):

  • Pulse synchronous tinnitus is very suggestive of IIH especially when it happens during headache periods. The reason of this voice is believed to be the vascular pulsation transmitted by high pressure CSF to the venous sinuses.[20][22]

Photopsia (48 to 54 percent):

  • Photopsias which defines as seeing flashes of light or sparkles may also be present in the course of IIH disease and can be exacerbate with change in position[20]

Back pain (53 percent):

  • These patients commonly report neck and back pain and stiffness.[1][9]

Retrobulbar pain (44 percent):

  • The most specific headache feature in IIH patients is retrobulbar pain with eye movement or glob compression[21]

Diplopia (18 to 38 percent):

Sustained visual loss (26 to 32 percent)[1]

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Wall M, George D (February 1991). "Idiopathic intracranial hypertension. A prospective study of 50 patients". Brain. 114 ( Pt 1A): 155–80. PMID 1998880.
  2. ↑ Soler D, Cox T, Bullock P, Calver DM, Robinson RO (January 1998). "Diagnosis and management of benign intracranial hypertension". Arch. Dis. Child. 78 (1): 89–94. PMC 1717437. PMID 9534686.
  3. ↑ 3.0 3.1 Bandyopadhyay S, Jacobson DM (March 2002). "Clinical features of late-onset pseudotumor cerebri fulfilling the modified dandy criteria". J Neuroophthalmol. 22 (1): 9–11. PMID 11937898.
  4. ↑ Ireland B, Corbett JJ, Wallace RB (March 1990). "The search for causes of idiopathic intracranial hypertension. A preliminary case-control study". Arch. Neurol. 47 (3): 315–20. PMID 2310315.
  5. ↑ Wall M, Kupersmith MJ, Kieburtz KD, Corbett JJ, Feldon SE, Friedman DI, Katz DM, Keltner JL, Schron EB, McDermott MP (June 2014). "The idiopathic intracranial hypertension treatment trial: clinical profile at baseline". JAMA Neurol. 71 (6): 693–701. doi:10.1001/jamaneurol.2014.133. PMC 4351808. PMID 24756302.
  6. ↑ Rogers AH, Rogers GL, Bremer DL, McGregor ML (June 1999). "Pseudotumor cerebri in children receiving recombinant human growth hormone". Ophthalmology. 106 (6): 1186–9, discussion 1189–90. doi:10.1016/S0161-6420(99)90266-X. PMID 10366091.
  7. ↑ Vischi A, Guerriero S, Giancipoli G, Lorusso V, Sborgia G (2006). "Delayed onset of pseudotumor cerebri syndrome 7 years after starting human recombinant growth hormone treatment". Eur J Ophthalmol. 16 (1): 178–80. PMID 16496267.
  8. ↑ 8.0 8.1 8.2 Friedman DI (2005). "Medication-induced intracranial hypertension in dermatology". Am J Clin Dermatol. 6 (1): 29–37. PMID 15675888.
  9. ↑ 9.0 9.1 Lessell S (1992). "Pediatric pseudotumor cerebri (idiopathic intracranial hypertension)". Surv Ophthalmol. 37 (3): 155–66. PMID 1475750.
  10. ↑ Ames D, Wirshing WC, Cokely HT, Lo LL (August 1994). "The natural course of pseudotumor cerebri in lithium-treated patients". J Clin Psychopharmacol. 14 (4): 286–7. PMID 7962691.
  11. ↑ Scott IU, Siatkowski RM, Eneyni M, Brodsky MC, Lam BL (August 1997). "Idiopathic intracranial hypertension in children and adolescents". Am. J. Ophthalmol. 124 (2): 253–5. PMID 9262557.
  12. ↑ Mushet GR (April 1977). "Pseudotumor and nitrofurantoin therapy". Arch. Neurol. 34 (4): 257. PMID 843266.
  13. ↑ Alexandrakis G, Filatov V, Walsh T (November 1993). "Pseudotumor cerebri in a 12-year-old boy with Addison's disease". Am. J. Ophthalmol. 116 (5): 650–1. PMID 8238233.
  14. ↑ Sheldon RS, Becker WJ, Hanley DA, Culver RL (November 1987). "Hypoparathyroidism and pseudotumor cerebri: an infrequent clinical association". Can J Neurol Sci. 14 (4): 622–5. PMID 3690435.
  15. ↑ 15.0 15.1 Bruce BB, Kedar S, Van Stavern GP, Corbett JJ, Newman NJ, Biousse V (June 2010). "Atypical idiopathic intracranial hypertension: normal BMI and older patients". Neurology. 74 (22): 1827–32. doi:10.1212/WNL.0b013e3181e0f838. PMC 2882219. PMID 20513819.
  16. ↑ Dave S, Longmuir R, Shah VA, Wall M, Lee AG (2008). "Intracranial hypertension in systemic lupus erythematosus". Semin Ophthalmol. 23 (2): 127–33. doi:10.1080/08820530801888188. PMID 18320479.
  17. ↑ Celebisoy N, Seçil Y, Akyürekli O (December 2002). "Pseudotumor cerebri: etiological factors, presenting features and prognosis in the western part of Turkey". Acta Neurol. Scand. 106 (6): 367–70. PMID 12460143.
  18. ↑ 18.0 18.1 Glueck CJ, Iyengar S, Goldenberg N, Smith LS, Wang P (July 2003). "Idiopathic intracranial hypertension: associations with coagulation disorders and polycystic-ovary syndrome". J. Lab. Clin. Med. 142 (1): 35–45. doi:10.1016/S0022-2143(03)00069-6. PMID 12878984.
  19. ↑ Chang D, Nagamoto G, Smith WE (1992). "Benign intracranial hypertension and chronic renal failure". Cleve Clin J Med. 59 (4): 419–22. PMID 1525975.
  20. ↑ 20.0 20.1 20.2 20.3 Giuseffi V, Wall M, Siegel PZ, Rojas PB (February 1991). "Symptoms and disease associations in idiopathic intracranial hypertension (pseudotumor cerebri): a case-control study". Neurology. 41 (2 ( Pt 1)): 239–44. PMID 1992368.
  21. ↑ 21.0 21.1 Wall M (December 1990). "The headache profile of idiopathic intracranial hypertension". Cephalalgia. 10 (6): 331–5. doi:10.1046/j.1468-2982.1990.1006331.x. PMID 2289234.
  22. ↑ Sismanis A, Butts FM, Hughes GB (January 1990). "Objective tinnitus in benign intracranial hypertension: an update". Laryngoscope. 100 (1): 33–6. doi:10.1288/00005537-199001000-00008. PMID 2293699.
  23. ↑ Chari C, Rao NS (October 1991). "Benign intracranial hypertension--its unusual manifestations". Headache. 31 (9): 599–600. PMID 1774176.

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