Pseudoturnor Cerebri

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Abstract
Pseudotumor cerebri is defined as a syndrome of increased intracranial pressure producing headache and papilledema, usually without other neurologic manifestations. The cerebrospinal fluid is under increased pressure but shows a normal total protein content and normal cell count. The pneumoencephalograms are within normal limits, without dilatation, deformity, or displacement of the ventricular system. This paper is based on the author''s personal experience with 61 cases, 15 of which were reported previously. Only nine of the 61 patients gave a history of previous middle ear infection. In 23 patients the syndrome was preceded by infection elsewhere in the body or trauma to the head. Twenty-nine patients gave no history of preceding infection; of these, 18 were women. The etiology of this condition is still unknown and probably variable. Those patients in whom the symptoms are preceded by infection of an ear or mastoid may well have mural thrombi in the superior longitudinal sinus or the major lateral sinus sufficient to interfere with cerebrospinal fluid absorption. To some extent this may also be true of the cases with preceding infection elsewhere than in the ear, or mastoid, or cerebral trauma. In nearly half of the 61 cases, the syndrome was not preceded by infection or trauma. In these cases it occurred more frequently in females than in males and was more common in the middle decades of life than at other ages. The etiology under these circumstances may be of a toxic or allergic nature, and in women may be related in some manner to menstrual disturbances of electrolyte balance. The treatment in all cases is aimed at relieving intracranial hypertension. In mild cases this can be done by limitation of fluid intake and promotion of water excretion alone. In cases with more severe papilledema, subtemporal decompression should be done first, followed by the above measures. The prognosis in the majority of cases is excellent, although many months or even several years may be required for the condition to subside completely. Because of the favorable outcome in most cases and the uncertainty as to the etiology, the designation "benign intracranial hypertension" suggested by Foley, especially for those cases not preceded by infection or trauma, seems a desirable one.

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