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Increased intracranial pressure
A little background on myself. I have had seizures for over a year and a half, I am a 35 year old woman. I have had normal mri and eeg, and had a lumbar punture 2 weeks ago that revealed my opening pressure to be 33. I have chronic headaches, tylenol or advil does not seem to help, I have episodes of dizziness and shaking in my hands, nausea, diarrhea, occasional vomiting, always tired, increased pressure in my eyes. My doctor doesn't seem to think that the opening pressure is a big deal, and said it was pseudotumor cerebri, saying that it wasn't high enough to do anything about. I am very frustrated, I feel terrible all of the time! I am not overweight, and from what I read her diagnosis leans toward overweight women. I am confused and any information would be greatly appreciated.
What is the norm for pressure? I know my head is killing me right now! Right behind my eyeballs like always. I haven't had the "pressure headache" (it feels like there is a tight band around my brain) since the spinal tap, but still the headache. I am allergic to sulpha drugs, and unfortunetly the drugs of choice to treat this are sulpha drugs.
Pseudotumor cerebri (PTC) is encountered most frequently in young, overweight women between the ages of 20 and 45.
Headache is the most common presenting complaint, occurring in more than 90 percent of cases. Dizziness, nausea, and vomiting may also be encountered, but typically there are no alterations of consciousness or higher cognitive function. Tinnitus, or a "rushing" sound in the ears, is another frequent complaint. Visual symptoms are present in up to 70 percent of all patients with PTC, and include transient visual obscurations, general blurriness, and intermittent horizontal diplopia. . Reports of ocular pain, particularly with extreme eye movements, have also been noted.
Therapy for patients with PTC varies, but in most instances initiate systemic medications as a first line treatment. Typically, the drug of choice for the initial management of PTC is oral acetazolamide (Diamox), although other diuretics including chlorthalidone (Hygroton) and furosemide (Lasix) may also be used effectively. Corticosteroid therapy is considered controversial in the management of PTC. While a short-term course of oral or intravenous dexamethasone may be helpful in initially lowering intracranial pressure, it is not considered to be an effective long-term therapy because of the potential for systemic and ocular complications.
For patients in whom conventional medical therapy fails to alleviate the symptoms and prevent pathologic decline, surgical intervention is the only definitive treatment. Cerebrospinal fluid shunting procedures are commonly employed in recalcitrant cases of PTC, but are successful in only 70 to 80 percent of cases. Optic nerve sheath decompression has also been advocated as a method to alleviate chronic disc edema, although this technique fails to directly address the issue of elevated intracranial pressure. It also demonstrates a particularly high failure rate.
Optometric management of patients diagnosed with PTC includes careful and frequent evaluation, including threshold visual fields, acuity measurement, contrast sensitivity, and indirect ophthalmoscopy. Photodocu-mentation of the nerve heads should also be performed.
http://www.revoptom.com/HANDBOOK/SECT53a.HTM
http://www.pseudotumorcerebri.com/
Headache is the most common presenting complaint, occurring in more than 90 percent of cases. Dizziness, nausea, and vomiting may also be encountered, but typically there are no alterations of consciousness or higher cognitive function. Tinnitus, or a "rushing" sound in the ears, is another frequent complaint. Visual symptoms are present in up to 70 percent of all patients with PTC, and include transient visual obscurations, general blurriness, and intermittent horizontal diplopia. . Reports of ocular pain, particularly with extreme eye movements, have also been noted.
Therapy for patients with PTC varies, but in most instances initiate systemic medications as a first line treatment. Typically, the drug of choice for the initial management of PTC is oral acetazolamide (Diamox), although other diuretics including chlorthalidone (Hygroton) and furosemide (Lasix) may also be used effectively. Corticosteroid therapy is considered controversial in the management of PTC. While a short-term course of oral or intravenous dexamethasone may be helpful in initially lowering intracranial pressure, it is not considered to be an effective long-term therapy because of the potential for systemic and ocular complications.
For patients in whom conventional medical therapy fails to alleviate the symptoms and prevent pathologic decline, surgical intervention is the only definitive treatment. Cerebrospinal fluid shunting procedures are commonly employed in recalcitrant cases of PTC, but are successful in only 70 to 80 percent of cases. Optic nerve sheath decompression has also been advocated as a method to alleviate chronic disc edema, although this technique fails to directly address the issue of elevated intracranial pressure. It also demonstrates a particularly high failure rate.
Optometric management of patients diagnosed with PTC includes careful and frequent evaluation, including threshold visual fields, acuity measurement, contrast sensitivity, and indirect ophthalmoscopy. Photodocu-mentation of the nerve heads should also be performed.
http://www.revoptom.com/HANDBOOK/SECT53a.HTM
http://www.pseudotumorcerebri.com/
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