Pseudotumor cerebri, also known as idiopathic intracranial hypertension (IIH), is a condition in which the pressure inside the skull is elevated without an identifiable cause such as a tumor, hemorrhage, or hydrocephalus. The increased pressure affects the brain and optic nerves and can lead to permanent vision loss if not treated.
The condition most commonly affects women of childbearing age, particularly those who are overweight. Despite its name (“false tumor”), pseudotumor cerebri is a serious medical condition that requires ongoing management.
Typical Symptoms
The hallmark of pseudotumor cerebri is headache combined with visual disturbances. Symptoms can range from mild to severely debilitating.
- Persistent headaches, often daily and worse with position changes
- Transient visual obscurations (brief episodes of vision dimming or graying)
- Double vision caused by pressure on the sixth cranial nerve
- Pulsatile tinnitus (a whooshing sound in the ears that follows the heartbeat)
- Pain behind the eyes
- Nausea
- Progressive vision loss if the condition is not controlled
Diagnosis and Treatment Path
Diagnosis involves a comprehensive eye examination showing papilledema (swelling of the optic nerve), brain imaging (MRI and MR venography) to exclude structural causes, and a lumbar puncture documenting elevated opening pressure. Treatment begins with weight management and medication. When medical therapy fails to control symptoms or vision is deteriorating, surgical options including CSF shunting or optic nerve sheath fenestration may be recommended.