Normal Pressure Pseudotumor Cerebri: A Series of Six Patients.

Abstract

Pseudotumor cerebri (PTC) is a condition characterized by symptoms and signs of increased intracranial pressure (ICP) with no intracranial mass or hydrocephalus, and with normal cerebrospinal fluid (CSF) composition. A variant of PTC known as "Normal Pressure Pseudotumor Cerebri" has the same features of PTC except for normal opening pressure. This is a series of 6 patients with typical symptoms and signs of increased ICP and normal neuroimaging, but with normal CSF opening pressure. A second lumbar puncture (LP) was done to re-measure the CSF opening pressure. The mean age of the patients at diagnosis was 25 years (ranging from 19 to 31 years). All patients were female. All patients were obese with a mean body mass index (BMI) of 32.8 (ranging from 30 to 35). The mean duration of symptoms before presentation was 2.8 weeks (ranging from 1 to 8 weeks). The mean CSF opening pressure during the first LP was 11 cm H2O (ranging from 9 to 15 cm H2O). The CSF chemistry and culture of all patients were normal. The mean CSF opening pressure in the second LP was 7.3 cm H2O (ranging from 6 to 10 cm H2O). All patients were symptom free after one week of treatment, but the medications were continued till the complete disappearance of papilledema and the normalization of the visual field. The mean duration of treatment was 8 weeks (ranging from 5 to 12 weeks). Normal pressure PTC should be treated by medical treatment to avoid visual loss.