Doctors Need to Be Aware of Possible Condition

Robert Blanchard

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With the rise in obesity, there is also expected to be a rise in obesity related medical conditions. Many such conditions only require long term management, but some require instant identification and appropriate medical intervention. Such is the case with the condition known as Pseudotumor Cerebris. Overweight women of childbearing age are at risk and the condition causes and increase in pressure inside the brain which can lead to blindness. If not properly identified, serious injury can result and there is the question of whether medical negligence led to the permanent injury.

Pseudotumor Cerebri, otherwise known as, Idiopathic intracranial hypertension (IIH) is a disorder of unknown etiology. It affects predominantly obese women of childbearing age. The primary problem is chronically elevated intracranial pressure (ICP), and the most important neurological manifestation is papilledema, which may lead to progressive optic atrophy and blindness. Although it is not a common disorder, clinicians must be familiar with its presentation so that it can be diagnosed and treated in a timely manner. Delay in treatment will result in a catastrophic outcome.

Symptoms of elevated ICP include headache that is nonspecific and varies in type, location, and frequency, pulsatile tinnitus - a rhythmic sound, heard in one or both ears, with pulsing synchronous rhythm that may be exacerbated by the supine or bending position, and horizontal diplopia - A symptom of a false-localizing sixth cranial nerve palsy.
Symptoms of papilledema include transient visual obscurations (e.g.: dimming or blackout of vision in one or both eyes lasting for a few seconds) which may be predominantly or uniformly orthostatic (i.e.: after bending over), progressive loss of peripheral vision in one or both of the eyes, most often starting in the nasal inferior quadrant, followed by loss of central visual field (possibly affecting visual acuity) and, lastly, loss of color vision, and blurring and distortion (i.e.: metamorphopsia) of central vision caused by macular wrinkling and subretinal fluid spreading from the swollen optic disc. Sudden visual loss is due to intraocular hemorrhage secondary to peripapillary subretinal neovascularization related to chronic papilledema.

Visual loss in one or both eyes can evolve rapidly despite the best efforts to arrest the process. Litigation centers on the delay of maximum medical and surgical management beyond what has to be considered ideal and standard practice in the United States for patients who present with rapidly declining vision.
The exact time window within which vision loss can be reversed after symptomatic decline is not known. Opinions among experts in the field vary as to how rapidly and aggressively any given patient should have been treated. Usually erring on the side of rapid intervention (hours to days) in such patients is better. This is a dramatic opportunity to save vision that can be easily lost. A major medicolegal pitfall is created when poor outcome is coupled with the perception of delayed treatment.

One of the standard teachings has been that pregnancy exacerbates or triggers the onset of symptomatic IIH. However, at present little statistical evidence exists of a causal association between the two conditions, beyond the fact that both events are common in the age group and gender that is predominantly affected by the disease.