Benign Intercranial Hypertension - Help!

  Please help - I am looking for information about Benign Intercraniel
  Hypertension. I was diagnosed 5 months ago and put on Diamox, which
  together with a lumbar Puncture, reduced the pressure. However, although
  I'm still on the medication, the symtoms (symptoms) are coming back (ie vision problems,
  severe headache, balance problems, speech problems and a general
  'vague' feeling).
  I don't know very much about this - do you have any information? What
  is it exactly? What causes it? Why have the symptoms returned? Is there
  anything that I can do to improve the condition?
  All the Neurologist has said is that it's unusual because I'm young, tall,
  and not overweight?!?
Dear Lisa,
Benign Intracranial Hypertension also known as pseudotumor cerebri is a syndrome that causes increased cerebral spinal fluid (CSF) pressures, however, the mechanism is unknown.  It is particularly frequent in fat adolescent girls and young women.  The increased pressures develop over weeks or months. Symptoms usually consist of a headache (dull, feeling of PRESSURE), blurred vision, vague dissiness, double vision, numbness of face, and occasionly a swooshing noise in the ear (audible bruit). On clinical exam, there may be swelling of the optic nerve head (papilledema). Aside from the papilledema the rest of the neurological exam is unremarkable. The CSF pressures are high of LP. MRI or CT scan of the brain show enlarged ventricles (the spaces where CSF is produced and stored in the head).  The first step of treatment is to rule out other disorders that cause similar symptoms (dural vnous sinus occlusion, gliomatosis cerebri, meningitis, AVM). This can be accomplished by CT or MRI, in addition to the LP results. Treatment initially requires multiple lumbar punctures to drain CSF and keep it within a normal range.  One study reported approximatly 1/3 of patients recovered near normal pressures after 6 months therapy.  In the larger group of patients in which the CSF remains elevated, the management is a bit more difficult and a bit contraversial.  It includes several meds 1. acetazolamide, 2. prednisone 3. oral hyperosmotic agents such as glycerol, and 4. lasix.  Reports indicate that there has been a gradual reduction of CSF prssures and recession of pepilledema with each of the above measures, but such responses were not consistent or sustained.  In patients who have CSF pressures that remain high and are unresponsive to the usual therapeutic measures, a permanent shunt can be placed (Approximatly 10% of patients require shunts).  The most serious consequence is visual loss due to pressures that are untreated or fail to repond.  Regular opthomalogical exams are important.  Other patients, may have persistent headaches despite low CSF pressures.  I hope this information answeres some of your questions.  Good Luck.
  Thanks,
  Lisa

[kiara00]

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