Possible Pseudotumer Cerebri??

[popeye8j]

I was taking doxycycline and developed a pressure sensation on the top of my head. I discontinued the doxycycline and a few days later the pressure sensation resolved. I was directed to continue taking the doxycycline and after I  took the first pill, I began to get a severe headache and nausea. The headache became so severe I went to the ED. They performed a CT Scan which was normal and a Lumbar Puncture Opening Pressure 22. After the LP, the head pressure resolved for 3 weeks. The head pressure returned and Ive had normal MRI/MRV/MRA/CT Sinus scans. I had 3 more lumbar punctures with no relief. The second OP was 18, third OP was 24. The fourth LP was when I was on diamox and the OP was 14. My ears are constantly popping and my left ear is constantly ringing. I have developed many floaters in my left eye but an eye exam revealed normal optic disks and visual fields. Could this still be a case of Pseudotumor Cerebri?? The head pressure is only slightly relieved by diamox.

[S. Kaul, MD]

Hi there!

This does not sound like pseudotumour cerebri. While the normal LP opening pressure lies between 1-20 in adults, values upto 25 are generally not considered to be high and though ‘long-term’ tetracycline use may be associated with PTC, doxycycline among the group is rarely associated with the condition.
                  Headaches can be caused by a variety of reasons often categorized into primary headaches, secondary headaches, and cranial neuralgias. The primary headaches include tension headache, migraine cluster headaches and similar pathologies. Secondary causes can be due to sinusitis eye problems, etc, and the cranial neuralgias that include the trigeminal neuralgias. Without a clinical evaluation it would be difficult to differentiate between these or suggest specific management. I would suggest getting this evaluated by an internist or a neurologist for an accurate diagnosis and appropriate management.
Hope this is helpful.

Take care!

[Paderla Anitha, DNB]

Hello and hope you are doing well.

Pseudotumor Cerebri is benign intracranial hypertension (BIH). The increased intracranial pressure associated with pseudotumor cerebri can cause swelling of the optic nerve and result in vision loss. As the pressures are varying and the optic disc is not swollen, the headaches may not be due to the raised tension. It could be due to migraine. Please discuss this with your doctor am sure he will provide further assistance.

Hope this helped and do keep us posted.