Pseudotumor cerebri. A not-always-benign imposter.

In patients with pseudotumor cerebri, visual loss may occur early or late. Patients with loss of vision at the time of diagnosis have a worse prognosis, but otherwise symptoms are not useful in predicting potential loss of vision. Systemic arterial hypertension is the only factor known to be important in risk for permanent loss of vision. CSF pressure may remain chronically elevated in most patients with benign intracranial hypertension regardless of whether or not the clinical syndrome recurs. Visual fields and acuity must be monitored meticulously in patients with pseudotumor cerebri, probably for life. Recurrences of the syndrome are not rare. Initial diagnosis requires performance of detailed neurologic and neuroophthalmologic examinations, computed tomographic scan of the brain, and lumbar puncture, in that order.