Pseudopseudotumor cerebri: meningeal carcinomatosis presenting as benign intracranial hypertension.

We have described a 63-year-old man, taking diethylstilbestrol for adenocarcinoma of the prostate, who had papilledema. Lumbar puncture revealed intracranial hypertension without pleiocytosis. CT scan was normal, consistent with the diagnosis of pseudotumor cerebri. At craniotomy for placement of a ventriculoperitoneal shunt, the dura was found to be infiltrated with adenocarcinoma. In patients with known malignancy and elevated intracranial pressure, lumbar puncture and CT scan alone are not enough to rule out meningeal carcinomatosis; repeated lumbar puncture or cervical cisternal puncture may be necessary to document malignant cytology.