Pseudotumor cerebri

The diagnosis of PTC is usually not difficult. Provided that the history, examination, neuroimaging studies, and lumbar puncture are all consistent with PTC, the diagnosis can be made easily. The elimination of "look-alikes" should be made with appropriate testing. After the diagnosis is made, patients should be observed closely in terms of their visual field and visual acuity until it is apparent that these are stable. Patients who have progressive loss of visual acuity or visual field should be treated promptly. An ophthalmologist should be involved in the care of these patients along with a neurologist or neurosurgeon, because visual loss may occur either early or late in the disease process and may be insidious. The most effective treatments are weight loss, carbonic anhydrase inhibitors, diuretics, and, if necessary, a short course of steroids. Blood pressure and IOP should be followed closely. If visual loss occurs despite these maneuvers, some type of shunt procedure, preferably optic nerve sheath decompression, is recommended. There seems to be no reason to treat the asymptomatic patient with PTC.