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* NBME form 2, block 4, Q29
 #393806  
  scorpinme - 03/18/09 19:15
 
  29. A 27-year-old woman comes to the physician because of increasingly severe daily headaches over the past 3months. The headaches are diffuse and often occur at the base of the skull. For the past month, she has had brief episodes of visual darkening when standing. She has been amenorrheic for the past year and has had an18-kg (40-lb) weight gain during this period. She now weighs 118 kg (260lb) and is 152 cm (60 in) tall. Funduscopic examination showspapilledema, several flame hemorrhages, and an enlarged blind spot bilaterally. Visual acuity is 20/20 bilaterally. A CT scan of the head shows noabnormalities. Which of the following is the most likely underlying cause of these findings?

A) Cerebral venous occlusion

B) Communicating hydrocephalus

C) Cytotoxic edema

D) Idiopathic intracranial hypertension

E) Impaired absorption of cerebrospinal fluid

F) Infratentorial mass lesion

G) Interstitial edema

H) Overproduction of cerebrospinal fluid

I) Vasogenic edema
 
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* Re:NBME form 2, block 4, Q29
#1691933
  kiranraja - 03/18/09 19:58
 
  E.  
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* Re:NBME form 2, block 4, Q29
#1692106
  metrowog7 - 03/18/09 21:47
 
  What's the Dx? More explanation, please...  
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* Re:NBME form 2, block 4, Q29
#1692161
  igorkrutoi - 03/18/09 22:21
 
  D)  
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* Re:NBME form 2, block 4, Q29
#1692358
  metrowog7 - 03/19/09 02:04
 
  I'm puzzled with E, B and H.
Anyone to comment?
 
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* Re:NBME form 2, block 4, Q29
#1692367
  cstopass - 03/19/09 02:25
 
  D. idiopathic intracranial hypertension=pseudotumor ceriberi.  
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* Re:NBME form 2, block 4, Q29
#1692378
  kiranraja - 03/19/09 02:57
 
  why not E.
Pseudotumor cerebri is caused by impaired absorption of CSF by arachnoid villi.
 
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* Re:NBME form 2, block 4, Q29
#1692381
  cstopass - 03/19/09 03:17
 
  http://en.wikipedia.org/wiki/Idiopathic_intracranial_hypertension

http://emedicine.medscape.com/article/1143167-overview

http://headaches.about.com/od/allheadpaintype1/a/what_ptc.htm
 
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* Re:NBME form 2, block 4, Q29
#1692753
  elbamaritza - 03/19/09 12:02
 
  E...we know the ethiology of pseudotumor cerebrei...that is impaired absortption...then is not idiopatic  
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* Re:NBME form 2, block 4, Q29
#1692853
  cstopass - 03/19/09 12:47
 
  We need to choose the BEST answer.

"idiopathic intracranial hypertension" is still the formal name for pseudotumor ceriberi. The exact mechanisms of pseudotumor ceriberi are not fully understood yet. the answers A, E, H may be partially correct, but not the best answer in this question.

some information from MKSAP14:

Idiopathic intracranial hypertension (pseudotumor cerebri) is a disturbance of increased intracranial pressure without evidence of intracranial disease, such as mass lesion, hydrocephalus, or venous sinus thrombosis. The pathophysiology of this condition is unclear but classically was believed to be related to decreased cerebrospinal fluid absorption. Recent evidence shows that narrowed cerebral venous drainage pathways may be involved in the pathogenesis of this idiopathic intracranial hypertension. This disorder occurs most commonly in obese women of childbearing age but also may be associated with tetracycline therapy, oral contraceptive use, and hypervitaminosis A.



 
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* Re:NBME form 2, block 4, Q29
#1695452
  charming - 03/21/09 10:57
 
  why not e  
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