pseudotumor cerebri..miss hyd,forever,m.king - ck4me

[ArchivalUser]

a woman presenting with pappiledema.. and headache double vision..You suspect pseudotumor
first step/next step will be giving

a/weight loss advice
b/acetazolamide
c/ct scan
d/lp

the idea of question is if u suspect pseudotumor will u confirm first or just start treatment??

[ArchivalUser]

first, do ct or mri with or without contrast

[ArchivalUser]

so if a pat comesto office with all these signs,,u dont give med,,u send home with ct mri script even tho it looks like pseudotumor?

[ArchivalUser]

you shouldnt sent the pt home with s/s of pseudo, need to move to the Er and do intial testing and treatment, high risk for complication sending the pt home

[ArchivalUser]

first step is CT scan and then you need LP . LP is both diagnostic and therapeutic in pseudotumor cerebri with severe symptoms.

if a person comes to office with these signs and if these signs are acute , it is important to rule out secondary causes of intracranial hypertension as soon as possible. If you do CT head from office it takes 3 hours and result will be back while patient is at home. But if you send the pt to ER, the result come sin 30 minutes and you can rule out other causes of this elevated intracranial tension.

Remember that pseudotumor is diagnosed according to the modified Dandy criteria which includes a) Symptoms and signs of increased intracranial pressure (eg, headache, transient visual obscurations, pulse synchronous tinnitus, papilledema, visual loss) + No other neurologic abnormalities or impaired level of consciousness + Elevated intracranial pressure with normal cerebrospinal fluid (CSF) composition ( so you need an LP) + A neuroimaging study that shows no etiology for intracranial hypertension ( So you need a CT scan) + No other cause of intracranial hypertension apparent.

So before you make a benign diagnosis like pseudotumor you must rule out dangerous causes . A CT scan + LP + making sure no mass lesions are pre-requisties for arriving at the diagnosis . So make sure you send the patient to ER, do imaging. If Imaging normal, proceed with Lumbar puncture and if CSF composition is normal, then send pt home if diagnosis comes out pure pseudotumor ( Dr.red CCS)

[ArchivalUser]

I thought MRI would be indicated instead of CT

[ArchivalUser]

Ct is the correct answer; it would show small ventricles. no need for mri . . you need to confirm Dx before startting acetazolamide. LP needed if acetaz and steroid are not efficient .