Facts regarding pseudotumor

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. These symptoms tend to worsen in association with Valsalva maneuvers and changes in posture. Reports of ocular pain, particularly with extreme eye movements, have also been noted.
Funduscopic evaluation of patients with PTC demonstrates bilaterally swollen, edematous optic nerves consistent with true papilledema. Ophthalmoscopy may reveal striations within the nerve fiber layer, blurring of the superior and inferior margins of the neural rim, disc hyperemia, and capillary dilatation. More severe presentations involve engorged and tortuous retinal venules, peripapillary hemorrhages and/or cotton wool spots, and circumferential retinal microfolds (Paton’s lines). Chronic papilledema mayresult in atrophy of the nerve head, with associated pallor and gliosis. Most cases of true papilledema will not present with a relative afferent pupillary defect, although visual field deficits may be present. The most common visual field defect associated with PTC is an enlarged blind spot, followed by a nasal deficit, typically affecting the inferior quadrants. Other field losses seen in PTC include arcuate defects, nasal step, generalized constriction, and least commonly, cecocentral scotoma.
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.

Taken from revoptom.com