Follow-up and decision making on treatment choices of the patient with established pseudotumor cerebri syndrome

Once a diagnosis of pseudotumor cerebri is established, the critical task becomes to protect the optic disc from excessive swelling potentially causing auto-infarction. Assessing tolerable versus threshold levels for such swelling, and selecting a treatment plan based on the degree of disc swelling and findings from perimetry will be reviewed. Technical and procedural steps will be exposed to reduce the chances of auto-infarction when large degrees of swelling are present using the principles of blood perfusion and regulation to the optic nerve head. Initiation of medical versus surgical treatment will be discussed. Precautions regarding intracranial pressure lowering techniques using lumbar puncture & drainage, optic nerve sheath fenestration, or shunt placement will be examined based on principles of blood perfusion as well as perineural sheath anatomy. Chronic long-term effects of disc swelling will also be addressed.