Treatment of pseudotumor cerebri: drugs to relieve discomfort and surgery

The goal of treatment for pseudotumour cerebri is to relieve symptoms and prevent visual impairment.

Lifestyle modification plays an indispensable role. It involves changing diet and introducing regular physical activity with the aim of reducing BMI values to at least below the obesity threshold.

A low-sodium diet is also useful to alleviate other symptoms.

Working with a dietician is most effective. Some people find that stomach surgery, known as bariatric surgery, in which part of the stomach is removed, helps with weight loss.

Medical treatment

The first choice of treatment is a medication used for glaucoma, i.e. increased intraocular pressure. One of these is acetazolamide. This medication can reduce the production of cerebrospinal fluid and thus relieve the symptoms of the disease.

Possible side effects include upset stomach, fatigue, tingling of the fingers, feet, mouth and kidney stones.

Another medication used is diuretics. These are used when acetazolamide alone is not effective. These two drugs are taken in combination.

Their effect is to increase the production of urine, thus eliminating retained fluid from the body.

To relieve headaches, similar therapies are used as for migraine, i.e. various analgesics, antiphlogistics, etc.

Surgical treatment

The first sign that surgery is necessary is a gradual loss of vision. At that time, the pressure around the optic nerves is surgically relieved or surgery is performed to reduce the intracranial pressure.

Fenestration of the optic nerve sheath

In this procedure, the surgeon creates a small window in the membrane that surrounds the optic nerve to allow excess cerebrospinal fluid to escape.

In most cases, vision is stabilized or improved. Interestingly, patients who undergo surgery on one eye also experience improvement in the other eye.

Ventriculoperitoneal shunt

In this type of surgery, a long thin tube (shunt) is inserted into the ventricle or base of the spine. It helps to drain excess cerebrospinal fluid. The other end of the tube is inserted into the abdomen where the fluid is reabsorbed into the body.

A complication of shunts is that they can easily become blocked. Therefore, further surgery is often necessary. Other complications include low pressure headaches and the risk of infection.

Venous stenting

This relatively new procedure is still rarely used. It involves placing a stent in one of the larger veins in the head to widen the venous sinus and increase the ability of blood to circulate.