Pseudotumor cerebri (PTC) syndrome is characterized by raised intracranial pressure causing headache in 90% and a normal neurological examination. Associated findings include papilledema (most of the time), and this can lead to visual loss. Headache really adds to the morbidity of this disorder and has the greatest effect on quality of life.
Pseudotumor cerebri syndrome can be idiopathic –like Idiopathic intracranial hypertension (IIH) or secondary like venous sinus thrombosis; therefore evaluation is critical. Imaging must be done to rule out space occupying lesions or venous thrombosis. Cerebrospinal fluid pressure and analysis of the CSF contents is essential.
While the diagnosis can be challenging, treatment is also problematic. The importance of weight loss improves intracranial pressure and papilledema grade. The new GLP1 receptor agonists, promoted for diabetes prevention and weight loss, have been preliminarily studied in IIH. Weight loss surgery has been shown be helpful in reducing pressure and papilledema. Lowering intracranial pressure by venous sinus stenting in the appropriate patient is a newer treatment for visual loss. Headache management is difficult since despite lowering intracranial pressure and weight loss, headache continues. Finally, idiopathic intracranial hypertension is a chronic disease with important implications for our patients.

The diagnosis of SIH is often difficult when brain MR imaging is normal. While orthostatic headache is the most common manifestation, a small percentage of patients never experience postural headaches and the orthostatic component may resolve over time. The presentation of SIH is quite variable, requiring some detective work for the clinician. Moreover, other conditions, such as POTS, chronic post-traumatic headache/post-concussion syndrome, and Chiari malformation have overlapping symptoms and may coexist with SIH. This talk addresses common and uncommon symptoms of SIH and provides features that help distinguish "SIH mimics" from spinal CSF leaks.

This presentation will discuss different case studies, their presentations and treatments for cure including percutaneous and surgical treatments for ruptured nerve root diverticuli and discs penetrating the dura; onyx embolization for CSF venofistulas, and surgeries for when these fail. Other unusual cases will include spinal cord hernias with associated leaks and complex csf veno fistula malformations and their treatment. also discussion of interventional treatments for high CSF pressure syndrormes