Headaches, pseudotumor cerebri without papilledema?

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  • Full Question:

    I am a 19 year old thin male diagnosed 9 months ago with Pseudotumor Cerebri without papilledema. This was diagnosed with 4 Lumbar Punctures done under fluoroscopy in the lateral, decubitus position. All 4 Lumbar Punctures showed opening pressures at 300. I am a pre-med, full academic scholarship student who had to withdraw from college due to eye pain/headaches that are worsened by reading. I had an LP shunt placed in May with a programmable valve and the pressure setting has been confirmed with a tap to be exactly normal at this time. However, I continue to have terrible eye pain and head pain. I have always been very near sighted, but have not lost any vision and have normal visual fields. I have been followed very closely by a neuro-ophthalmologist and a neurosurgeon.

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    I am seeking your advice as to a possible solution for pain relief. I am currently on Neurontin (900mg per day) and take Indocin 75mg at night. The Indocin is the only med that has made a slight difference in the pain upon waking up. The Neurontin seems to be helping slightly. I still struggle to read. I am wanting very much to be a full time student again! Thank you very much for your help. B.


    Full Answer:

    Dear B.;


    Adding oral acetazolamide may be helpful to lower chronic increased central fluid pressure. We have had limited success with mannitol IV in the clinic as well. Your Neurontin dosage may be low as headache/pain studies were done at 3600 mg or more.


    These are, of course, suggestions for you to discuss with your doctors, who may or may not find them helpful. It's always difficult to make specific suggestions for patients we've never seen.


    Good luck,
    John Claude Krusz and Teri Robert



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    Dr. Krusz is a recognized expert in the fields of headache and  Migraine treatment and pain treatment. Each week, he and Lead Expert Teri Robert, team up to answer your questions about headaches and  Migraines. You can read more about Dr. Krusz or more about Teri Robert.


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    Last updated March 7, 2011.

Published On: March 07, 2011