Pseudotumor cerebri can cause symptoms that resemble a brain tumor.
Learn the differences between the two conditions, the symptoms and the treatment options from a UVA neurosurgeon who specializes in pseudotumor cerebri.
Selected Podcast
Having Brain Tumor Symptoms Without a Tumor
Featured Speaker:
Dr. Kenneth Liu
Dr. Kenneth Liu is a fellowship-trained neurointerventional surgeon who specializes in caring for patients with aneurysms and stroke as well as brain and spinal vascular malformations. Transcription:
Having Brain Tumor Symptoms Without a Tumor
Melanie Cole (Host): Pseudotumor cerebri can cause symptom that resemble a brain tumor but is different from that. My guest is Dr. Kenneth Liu. He’s a fellowship-trained neurointerventional surgeon who specializes in caring for patients with aneurysm and stroke, as well as brain and spinal vascular malformations at UVA Neuroscience: Brain & Spine Care. Welcome to the show, Dr. Liu.
Dr. Kenneth Liu (Guest): Thank you, Melanie.
Melanie: So tell us a little bit about pseudotumor cerebri.
Dr. Liu: Pseudotumor is a condition that no one really knows a lot about it. What it basically is is a patient will present with increased pressures in their brain and can develop symptoms of severe headache. They can develop visual loss, and they can have a ringing in their ears. But it can be a fairly debilitating condition.
Melanie: People are going to have some of these symptoms, and right away they’re going to think that they have a brain tumor. It can be very scary. What red flags would people have that would send them to see you?
Dr. Liu: I think typically these patients first go to either their family physician. And with someone who’s demonstrating symptoms of increased pressures in their brain, such as headaches and maybe visual loss, the doctor will usually have them see an ophthalmologist and also undergo some non-invasive brain imaging. Typically, the brain imaging will be fairly normal—no tumors, no aneurysms, nothing scary, anything like that. And when the eye doctor looks into the patient’s eyes, they’ll see pressure behind the eyes or fluid built up behind the eyes. In those sorts of situations, you can almost diagnose the patient with pseudotumor at that time. Typically, I’ll get involved at that point.
Melanie: What are some risk factors for pseudotumor?
Dr. Liu: Now, that’s a really great question. I don’t think anyone really knows the answer to that question. A lot of patients with pseudotumor tend to be young female patients from about age 20 to 35, 40 years old. They do tend to be overweight. But I do see patients with pseudotumor that are the complete opposite of that. They’re male, they’re older. So I think that there does tend to be a population of patients who can get this, but it really can affect everyone. Some people think that if you take too much of Vitamin A, you can get pseudotumor, but I don’t know that that’s really been proven.
Melanie: So, Dr. Liu, is pseudotumor an emergent condition? If people would come to see you, you would diagnose this. Is this something emergent that you have to do something about very quickly? Can it predispose someone to stroke or other problems?
Dr. Liu: Generally, it’s not an emergency condition, but it’s a condition I think a lot of physicians can be fooled by it because it appears benign. The result of imaging is normal and there’s no tumor, there’s nothing to worry about, but the reality is that these patients do indeed have high pressures inside their skull, high pressures inside their brain, which can lead to permanent visual loss. So it is something that should be investigated in a fairly aggressive process. And there have been patients, I’ve had patients who do present in a very emerging fashion who do need to go under treatment right away to decrease the pressures in their head and to save their vision.
Melanie: Tell us about treatments, Dr. Liu. What treatment options are available?
Dr. Liu: A lot of the more traditional treatment options for pseudotumor are aimed at trying to get the pressures in the head to come down. Traditionally, there haven’t been a lot of great ways to do that. Typically, patients will often experience relief when spinal fluid is drained from their brains, so either they undergo a spinal tap or have some kind of drain placed and some fluid is taken off. Typically, that will give them some temporary relief. A lot of times, when patients get relief from that, neurosurgeons such as myself, will put in something that’s called a shunt, which is basically a permanent drainage system that drains spinal fluid from the brain to another spot in your body, such as the abdomen. While these shunts can be helpful, it’s really not treating the underlying condition, and about 5, 10 years ago, some of us realized that some of that there’s a subset of these pseudotumor patients that actually have narrowing in the veins that drain blood from the brain. What that narrowing of the veins does is it essentially causes a traffic jam in the brain and causes blood to back up, and that’s why the pressures go up. You can sort of imagine it similar to a clogged toilet. So a shunt, if you were to use that analogy, a shunt is something like if your toilet’s clogged, you kind of use a bucket or a cup to drain the toilet, which doesn’t really fix the underlying issue. One of the latest treatments that we’ve been pioneering here at UVA is using a balloon and a stent to minimally invasively open up these areas of narrowing. What that does is that improves the drainage of blood from the brain, decreases the traffic jam, gets rid of the blood backing up, and these patients will actually, their pressures will actually return to normal. A lot of times, their vision will improve and their headaches will get better as well.
Melanie: What about medications? Is there something in lifestyle changes, anything you want the listeners to know? And what kind of medications might they go on after this treatment?
Dr. Liu: There probably aren’t a whole lot of lifestyle changes that a patient can make. A lot of us will recommend trying weight loss initially, but I know that can be very difficult, and the results are variable with that approach. Some physicians will try to, before any kind of invasive treatments, some physicians will try a medicine called Diamox to try to decrease the amount of spinal fluid that’s produced. Again, that doesn’t really treat the underlying issue of potentially having veins that are narrowed veins or blocked veins that are causing the pressures to build up, and a lot of patients don’t really tolerate Diamox that well. It makes them feel very funny. As far as medications that someone might be on, after a stent is placed, anytime a stent is put in the body, whether it’s in your heart or your brain or your leg or anywhere else, a stent -- stents are made out of metal, and so, patients will typically need to be on a short course of blood thinners to kind of keep the blood lubricated while the stent heals into the blood vessel. And that’s the same thing that happens when you have a stent placed in a vein in your brain. You will need to -- typically, we have patients on two blood thinners. One is an Aspirin. The other one is a medicine called Pladex, which I’m sure that everyone has seen TV commercials for it. But typically, patients are on these for maybe three to six months after the procedure, and then we kind of start tapering them off at that point.
Melanie: Dr. Liu, why should patients choose UVA to receive treatment for brain conditions?
Dr. Liu: Well, I think the great thing about UVA is that I think you have a tremendous number of very smart, very bright people here that are leaders in their field, not only in neurosurgery but in areas such as radiology and endrocrinology, and almost every specialty there has… I know there are tremendously bright people there, and they are considered national experts. For something like pseudotumor, you have neurosurgeons, myself and my partner, Dr.Crowley, who are both trained, and we’re sort of the 21st century neurosurgeons. We’re trained in both open techniques and minimally invasive techniques and we’re able to tailor patients treatments to what we think is the safest and most effective treatment option. Then I have colleagues in interventional neuroradiology who also have a lot of experience placing stents in the brain. And so actually, I think here at UVA, not only do we have lot of bright people, but there’s a tremendous amount of collaboration, and I think we’re all very excited about figuring out things that we can do to push the field forward and give and provide what we think is the best care for patients.
Melanie: Thank you so much, Dr. Kenneth Liu. You are listening to UVA Health Systems Radio. You can get more information at uvahealth.com. This is Melanie Cole. Thanks for listening.
Having Brain Tumor Symptoms Without a Tumor
Melanie Cole (Host): Pseudotumor cerebri can cause symptom that resemble a brain tumor but is different from that. My guest is Dr. Kenneth Liu. He’s a fellowship-trained neurointerventional surgeon who specializes in caring for patients with aneurysm and stroke, as well as brain and spinal vascular malformations at UVA Neuroscience: Brain & Spine Care. Welcome to the show, Dr. Liu.
Dr. Kenneth Liu (Guest): Thank you, Melanie.
Melanie: So tell us a little bit about pseudotumor cerebri.
Dr. Liu: Pseudotumor is a condition that no one really knows a lot about it. What it basically is is a patient will present with increased pressures in their brain and can develop symptoms of severe headache. They can develop visual loss, and they can have a ringing in their ears. But it can be a fairly debilitating condition.
Melanie: People are going to have some of these symptoms, and right away they’re going to think that they have a brain tumor. It can be very scary. What red flags would people have that would send them to see you?
Dr. Liu: I think typically these patients first go to either their family physician. And with someone who’s demonstrating symptoms of increased pressures in their brain, such as headaches and maybe visual loss, the doctor will usually have them see an ophthalmologist and also undergo some non-invasive brain imaging. Typically, the brain imaging will be fairly normal—no tumors, no aneurysms, nothing scary, anything like that. And when the eye doctor looks into the patient’s eyes, they’ll see pressure behind the eyes or fluid built up behind the eyes. In those sorts of situations, you can almost diagnose the patient with pseudotumor at that time. Typically, I’ll get involved at that point.
Melanie: What are some risk factors for pseudotumor?
Dr. Liu: Now, that’s a really great question. I don’t think anyone really knows the answer to that question. A lot of patients with pseudotumor tend to be young female patients from about age 20 to 35, 40 years old. They do tend to be overweight. But I do see patients with pseudotumor that are the complete opposite of that. They’re male, they’re older. So I think that there does tend to be a population of patients who can get this, but it really can affect everyone. Some people think that if you take too much of Vitamin A, you can get pseudotumor, but I don’t know that that’s really been proven.
Melanie: So, Dr. Liu, is pseudotumor an emergent condition? If people would come to see you, you would diagnose this. Is this something emergent that you have to do something about very quickly? Can it predispose someone to stroke or other problems?
Dr. Liu: Generally, it’s not an emergency condition, but it’s a condition I think a lot of physicians can be fooled by it because it appears benign. The result of imaging is normal and there’s no tumor, there’s nothing to worry about, but the reality is that these patients do indeed have high pressures inside their skull, high pressures inside their brain, which can lead to permanent visual loss. So it is something that should be investigated in a fairly aggressive process. And there have been patients, I’ve had patients who do present in a very emerging fashion who do need to go under treatment right away to decrease the pressures in their head and to save their vision.
Melanie: Tell us about treatments, Dr. Liu. What treatment options are available?
Dr. Liu: A lot of the more traditional treatment options for pseudotumor are aimed at trying to get the pressures in the head to come down. Traditionally, there haven’t been a lot of great ways to do that. Typically, patients will often experience relief when spinal fluid is drained from their brains, so either they undergo a spinal tap or have some kind of drain placed and some fluid is taken off. Typically, that will give them some temporary relief. A lot of times, when patients get relief from that, neurosurgeons such as myself, will put in something that’s called a shunt, which is basically a permanent drainage system that drains spinal fluid from the brain to another spot in your body, such as the abdomen. While these shunts can be helpful, it’s really not treating the underlying condition, and about 5, 10 years ago, some of us realized that some of that there’s a subset of these pseudotumor patients that actually have narrowing in the veins that drain blood from the brain. What that narrowing of the veins does is it essentially causes a traffic jam in the brain and causes blood to back up, and that’s why the pressures go up. You can sort of imagine it similar to a clogged toilet. So a shunt, if you were to use that analogy, a shunt is something like if your toilet’s clogged, you kind of use a bucket or a cup to drain the toilet, which doesn’t really fix the underlying issue. One of the latest treatments that we’ve been pioneering here at UVA is using a balloon and a stent to minimally invasively open up these areas of narrowing. What that does is that improves the drainage of blood from the brain, decreases the traffic jam, gets rid of the blood backing up, and these patients will actually, their pressures will actually return to normal. A lot of times, their vision will improve and their headaches will get better as well.
Melanie: What about medications? Is there something in lifestyle changes, anything you want the listeners to know? And what kind of medications might they go on after this treatment?
Dr. Liu: There probably aren’t a whole lot of lifestyle changes that a patient can make. A lot of us will recommend trying weight loss initially, but I know that can be very difficult, and the results are variable with that approach. Some physicians will try to, before any kind of invasive treatments, some physicians will try a medicine called Diamox to try to decrease the amount of spinal fluid that’s produced. Again, that doesn’t really treat the underlying issue of potentially having veins that are narrowed veins or blocked veins that are causing the pressures to build up, and a lot of patients don’t really tolerate Diamox that well. It makes them feel very funny. As far as medications that someone might be on, after a stent is placed, anytime a stent is put in the body, whether it’s in your heart or your brain or your leg or anywhere else, a stent -- stents are made out of metal, and so, patients will typically need to be on a short course of blood thinners to kind of keep the blood lubricated while the stent heals into the blood vessel. And that’s the same thing that happens when you have a stent placed in a vein in your brain. You will need to -- typically, we have patients on two blood thinners. One is an Aspirin. The other one is a medicine called Pladex, which I’m sure that everyone has seen TV commercials for it. But typically, patients are on these for maybe three to six months after the procedure, and then we kind of start tapering them off at that point.
Melanie: Dr. Liu, why should patients choose UVA to receive treatment for brain conditions?
Dr. Liu: Well, I think the great thing about UVA is that I think you have a tremendous number of very smart, very bright people here that are leaders in their field, not only in neurosurgery but in areas such as radiology and endrocrinology, and almost every specialty there has… I know there are tremendously bright people there, and they are considered national experts. For something like pseudotumor, you have neurosurgeons, myself and my partner, Dr.Crowley, who are both trained, and we’re sort of the 21st century neurosurgeons. We’re trained in both open techniques and minimally invasive techniques and we’re able to tailor patients treatments to what we think is the safest and most effective treatment option. Then I have colleagues in interventional neuroradiology who also have a lot of experience placing stents in the brain. And so actually, I think here at UVA, not only do we have lot of bright people, but there’s a tremendous amount of collaboration, and I think we’re all very excited about figuring out things that we can do to push the field forward and give and provide what we think is the best care for patients.
Melanie: Thank you so much, Dr. Kenneth Liu. You are listening to UVA Health Systems Radio. You can get more information at uvahealth.com. This is Melanie Cole. Thanks for listening.