Risk Factors Linked To Pseudotumor Cerebri

April 9, 2024

Pseudotumor cerebri, also known as idiopathic intracranial hypertension, is a neurological condition in which there is abnormally high pressure in the brain. The elevated pressure develops when an excessive amount of cerebrospinal fluid builds up in the brain itself; this accumulation can happen because of increased cerebrospinal fluid production or decreased cerebrospinal fluid absorption. The symptoms of this benign condition mimic those of a malignant brain tumor. Patients typically have vision loss, blurry vision, or double vision, and they may also have dizziness, vomiting, and nausea. These symptoms are generally accompanied by tinnitus, trouble walking, stiffness in the neck, and frequent headaches. Some pseudotumor cerebri patients could develop depression, and lapses in short-term memory are common. To diagnose this condition, doctors perform a physical examination, including a neurological examination. Tests such as CT scans, MRI scans, eye function studies, and a spinal tap are used to confirm a diagnosis. Thankfully, there are effective treatments for pseudotumor cerebri.

The risk factors described below are often associated with pseudotumor cerebri.

Certain Medications

The use of certain medications can increase an individual's risk of developing pseudotumor cerebri. In particular, growth hormones, tetracycline, and excessive amounts of vitamin A are correlated with an elevated risk. Lithium and some types of steroid medication may also increase a patient's risk of pseudotumor cerebri. Patients taking one or more of these medications and who also have other risk factors for pseudotumor cerebri may wish to ask their medical team about switching medications. Doing so may reduce their risk, and alternatives are available in most cases. For example, lithium is an older medication commonly prescribed for mental health conditions. Newer, more effective medications are now available that don't adversely impact the patient's risk of pseudotumor cerebri. Tetracycline is an antibiotic, and many other antibiotics exist within the same category. If an alternate medication cannot be prescribed, patients at especially high risk of pseudotumor cerebri should try to take these medications for the shortest amount of time as they can and at the lowest effective dosage.

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Being obese is one of the strongest risk factors for the development of pseudotumor cerebri, particularly for women. Women under forty-four years old who are obese are especially susceptible. In the general population, the average prevalence of pseudotumor cerebri is approximately one or two in 100,000 individuals. Among obese women, pseudotumor cerebri occurs in an estimated four to twenty-one individuals out of every 100,000. Given the strong correlation between obesity and pseudotumor cerebri, doctors often recommend weight loss as the first line of treatment. Patients may be advised to make dietary changes, including reducing their fat and salt intake, and some patients may also need to limit fluids. To help with weight loss and reduce fluid retention, patients may be prescribed diuretics, which enable the body to release excess fluid through urination. Patients struggling with their weight might wish to join a weight loss support group or consult a nutritionist.

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Behcet's Disease

Behcet's disease causes patients to develop inflammation in the blood vessels throughout the body, and this may predispose them to the development of pseudotumor cerebri. The autoimmune disease creates swelling in the brain that may lead to fevers, headaches, disorientation, difficulties with balance, and strokes. Behcet's disease is most often diagnosed in young adults in their twenties and thirties, and it is most severe in males. Like pseudotumor cerebri, Behcet's disease leads to vision problems, including vision loss. The good news is there are quite a few treatments for Behcet's disease. Since certain steroid medications can increase the risk of pseudotumor cerebri, Behcet's disease patients may wish to ask about alternative medications.

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Sleep Apnea

Sleep apnea is a serious condition that causes patients to stop breathing multiple times while they are sleeping. As with pseudotumor cerebri, one of the major risk factors for this condition is obesity. Symptoms of sleep apnea include gasping for air during sleep, snoring loudly, and feeling very tired during the day. Patients may also struggle with irritability and have difficulty concentrating. Morning headaches and dry mouth have been reported as well. Treatment for sleep apnea includes weight loss and the use of a CPAP machine that provides continuous positive airway pressure throughout the night to ease breathing. Some patients may be able to use a Bi-PAP machine that provides airflow in a more comfortable way. Various oral appliances may also be recommended, and surgery is used as a last resort. Patients with sleep apnea may wish to speak with their healthcare team about their risk of pseudotumor cerebri, and they should immediately inform their doctor if they develop vision changes or other symptoms of pseudotumor cerebri.

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Addison's Disease

Addison's disease, an autoimmune condition, develops when the body's adrenal glands, located on the kidneys, fail to produce sufficient cortisol and aldosterone. The condition occurs in approximately one out of every 100,000 individuals in the United States, and it is typically diagnosed in individuals between thirty and fifty years old. Symptoms of Addison's disease include depression, menstrual irregularities, nausea, vomiting, weight loss, and abdominal pain. Some patients may experience low blood pressure and low blood glucose as well. Blood tests, x-rays, and CT scans aid in the diagnosis of Addison's disease. Treatment includes hydrocortisone pills to replace cortisol in the body, and patients are also given hormones that replace the ones the adrenal glands normally produce. Since Addison's disease can increase a patient's risk of pseudotumor cerebri, patients should be aware of the symptoms of both conditions, and any concerns should be mentioned to their healthcare providers.

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