A 33-year-old woman complains of generalized, throbbing headache that is worse in the morning and with coughing. She occasionally feels dizzy and nauseated. Examination is significant only for obesity and bilateral papilledema. ACT scan of the head is normal. At lumbar puncture, the opening pressure is 220 mmH2O; CSF is clear, with protein of 12 mg/100 mL (normal, 1545), glucose of 68 mg/100 mL (normal, 4580), and no cells are seen. Which of the following is the most likely diagnosis?
- migraine headache
- multiple sclerosis
- malignant carcinomatosis
- pseudotumor cerebri
- glaucoma
Answer(s): D
Explanation:
Pseudotumor cerebri is a disorder of increased intracranial pressure that has no obvious cause. The typical patient is an obese young woman who complains of headache and is found to have papilledema. Slight decrease in visual fields and enlargement of blind spots may also be observed. Neurologic examination is otherwise normal, and the patient appears to be healthy. CSF is under increased pressure and may have slightly low protein concentration, but is otherwise normal. CT scan, arteriogram, and other x-ray studies are usually normal. The most serious complication is severe visual loss, which occurs in about 10% of affected persons. Treatment with a carbonic anhydrase inhibitor decreases intracranial pressure by decreasing production of CSF. Weight loss is important but often unsuccessful. If the carbonic anhydrase inhibitor and weight loss fail, or if visual loss develops, lumboperitoneal shunting or optic nerve sheath fenestration are important maneuvers to prevent blindness.