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Forum Name: Neurology Topics

Question: can recurrung head injuries cause Pseudotumor Cerebri?


 AliLynnSmith - Wed Dec 09, 2009 6:59 pm

have been admitted to the hospital three times since the first injury and I have seen 8 Doctors, 2 of them being Neurologists. Here is some of my background: Prior to all of this I was a perfectly normal 17 year old, nothing wrong, very athletic, and very academic. On July 29 I was involved in a serious car accident (not my fault) and sustained a concussion. At first I was very combative, and then on the way to the hospital I became unresponsive. I was completely unresponsive for over five hours, I did not respond to any stimuli (pain, touch, noise). I also broke my pelvis in 3 places, although this has healed at this point. My glasses were in my purse at the time of the accident because I had contact lenses in, so they were broken. I went to my Ophthalmologist to get new glasses and he noticed that my optic nerves were full and swollen, this was in early June. I returned to him in the middle of June and he said that they had returned to normal size, I never noticed any difference in my vision or any severe headaches or odd dizziness or lightheadedness. We did follow up with a neurologist following the first accident because I was having short term memory problems, just to make sure it was part of Post-Concussive Syndrome. He did an EEG and an MRI and concluded that I was just suffering from Post-Concussive syndrome like we expected. In September/October I started to notice severe headaches, and I was very dizzy and light headed. He put me on a few types of mild migraine medicines that did not even phase the headaches. He then put me on Topomax on (about) Nov3. Although, the second brain injury occurred on November 1st (again not my fault) and I sustained another concussion. This was no where as severe as the first, I did not lose consciousness. On November 10th I started to notice my vision was blurred, and then on November 15th it was crossed and I was seeing double to the point that I could not function. I went to my ophthalmologist on November 16th and he noticed that my Optic Nerves were extremely swollen, and he did a Vision Field Test and it showed my vision was not what it should be. I stopped all medication that I was taking He called my neurologist and they decided that I needed a LP and a CT, I had these on Nov 20th. The CT was normal and the LP showed my pressure was at least 37 because the PA stopped before the pressure reading was complete. After they took out 3 vials of fluid, my symptoms did not decrease. My neurologist informed us on Dec 3 that the LP lab results were clear and he had no idea what to do next, to follow up with the Ophthalmologist. My Ophthalmologist felt I needed a more in depth exam, I was admitted into the hospital on Dec 4th. I had a regular MRI, a contrast dye MRI, and another LP. The MRIs were normal, as expected, and my pressure was not as high this time, but they did not expect it to be seeing as how my last LP was two weeks ago. He reduced my pressure down to below 6, and my symptoms still did not let up, and my optic nerves are still swollen. I went to the Ophthalmologist on Dec 7 and my optic nerves were still swollen and the Vision Field Test was progressively worse than it was the first time. I am on Topomax again for the headaches, it is not working. I am also on Vicodin, which is also not working. Some of the doctors are thinking Pseudotumor Cerebri; could recourring brain injuries cause this? I'm just wondering someone else's input. Thanks SO much! I am 18 now, and would LOVE to get back to my senior year in high school.
 Dr.M.Aroon kamath - Tue Dec 15, 2009 8:24 pm

User avatar Hi,

Pseudotumor cerebri (PTC), or idiopathic intracranial hypertension, is a condition characterized by signs and symptomatology of abnormally elevated intracranial pressure (ICP) in the absence of a space-occupying lesion.

Can be classified broadly as
- primary (idiopathic), meaning that the cause is unknown and
- secondary, meaning that there is an underlying cause
(other than a space-occupying lesion).

Pathogenesis is unknown, but most of the available evidence indicates that it could be
- resistance to CSF absorption at the arachnoid villi(where normal absorbtion of CSF occurs into the venous blood or
- Stenosis(narrowing) of some of the major intracranial venous sinuses(notably the transverse sinus)

Post-pubertal women (especially obese) are at a higher risk.There are several other etiological factors (infections-notably middle ear infections and mastoiditis; drugs; endocrine disorders etc).

Most cases in adults will turn out to be of the primary variety.Typically, a specific cause can be usually identified among young children. In children <6 years, a specific cause for intracranial hypertension can usually be identified (secondary pseudotumor cerebri). Primary or idiopathic cases are usually seen after the age of 11 years.

Historically.the association between minor head injury and Pseudotumor cerebri has been quoted eversince this condition was first described.Although, no definite association has been proven beyond doubt.

One may say that in most reported series of cases in the medical literature, there is likely to be a small but, significant proportion of cases with a recent history of minor head injury.

Significant head trauma can lead to dural venous sinus thrombosis and thus can result in raised ICP.

In conclusion, one may only say that the relationship of head trauma to pseudotumor cerebri is at best unclear.

Best wishes!
 AliLynnSmith - Tue Dec 15, 2009 10:48 pm

I am not obese, or even overweight. My BMI is 24, so I do not think that the two are related. Thank you for replying! I am seeing the 9th doctor tomorrow, and another one on Friday. I appreciate your response. Is it possible that I just have hydrocephalus from the head injuries, even though the CSF has been removed twice to a pressure of below 6, and has risen back?
 Dr.M.Aroon kamath - Mon Jan 04, 2010 9:58 am

User avatar Hi,
Although pseudotumor cerebri is said to be more common in obese women, it can occur in persons with any BMI. Most conditions do not follow 'text book descriptions'.
Please keep us updated.Good luck to you!
 AliLynnSmith - Mon Jan 04, 2010 12:43 pm

Just realized that I spelt "recurring" wrong on accident :)

I am having a third spinal tap done tomorrow actually, and they are discussing inserting a shunt, I will know more after tomorrow's appointment and pressure reading.

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