Pseudotumor cerebri & LP

[Dreamin]

Out of curiosity...

Obviously prior to doing an LP a CT is done to rule out increased intracranial pressure and thus prevent brainstem herniation into the foramen magnum...

Why is it that in the case of Pseudotumor cerebri that even though there is increased intracranial pressure we are not concerned about the risk of brainstem herniation...when LP can be used to treat this type of headache?

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[NR117]

Out of curiosity...

Obviously prior to doing an LP a CT is done to rule out increased intracranial pressure and thus prevent brainstem herniation into the foramen magnum...

Why is it that in the case of Pseudotumor cerebri that even though there is increased intracranial pressure we are not concerned about the risk of brainstem herniation...when LP can be used to treat this type of headache?

The CT is not done to rule out increased intracranial pressure; it's done to rule out an intracranial mass causing increased intracranial pressure. In pseudotumor cerebri, the pressure is distributed evenly and that's why you don't get herniation.
Serial LP's used to be part of the management of pseudotumor cerebri a very very long time ago, before it was discovered that it's totally unnecessary to put patients throught that, when you can treat it pharmacologically.

 

[Dreamin]

The CT is not done to rule out increased intracranial pressure; it's done to rule out an intracranial mass causing increased intracranial pressure. In pseudotumor cerebri, the pressure is distributed evenly and that's why you don't get herniation.
Serial LP's used to be part of the management of pseudotumor cerebri a very very long time ago, before it was discovered that it's totally unnecessary to put patients throught that, when you can treat it pharmacologically.

Thanks for the explanation & I do know that a CT does not show increased intracranial pressure...but may show mass indicating increased ICP.

Interestingly, I did see a patient this year on my neuro rotation who did not respond to pharmocologic intervention and did require therapeutic LP to relieve her headaches.

 

[neurologist]

Thanks for the explanation & I do know that a CT does not show increased intracranial pressure...but may show mass indicating increased ICP.

Interestingly, I did see a patient this year on my neuro rotation who did not respond to pharmocologic intervention and did require therapeutic LP to relieve her headaches.

FYI, they can also be given a shunt (lumboperitoneal).

 

[NR117]

FYI, they can also be given a shunt (lumboperitoneal).

Or ventriculoperitoneal.