With chronic papilledema, constriction of the visual field, especially inferiorly, gradually can occur, which eventually may progress to a loss of central acuity and total blindness. Stereo color photographs of the optic discs are useful to document changes. A lumbar puncture should be performed following a normal MRI to assess the opening pressure of the CSF and to obtain CSF for analysis to rule out neoplastic and infectious etiologies. It may provide some therapeutic benefit as the CSF pressure is reduced temporarily. Specific therapy should be directed to the underlying mass lesion if present.
Weight reduction is recommended in cases of pseudotumor cerebri.
The underlying mass lesion, if present, should be removed. Optic nerve sheath decompression can be used to relieve worsening ocular symptoms in cases of medically uncontrolled pseudotumor cerebri. This procedure probably will not ameliorate persistent headaches if present. Besides an ophthalmologist, a neurologist should be involved in monitoring the patient, and a neurosurgeon may be needed to help evaluate any underlying mass or to perform a shunting procedure. Dietary restrictions and consultation with a dietitian in case of pseudotumor cerebri is recommended.