To the Editor.
—Disagreement exists over the role of lumbar puncture in the diagnosis of pseudotumor cerebri (benign intracranial hypertension). One view holds that normal computed tomographic (CT) scans obviate the need for lumbar puncture to confirm the diagnosis.1,2 Others recommend lumbar puncture for diagnosis in all cases3-6 or serially in selected patients to monitor response to treatment.7 In reviewing the literature we found a paucity of reports documenting the need for cerebrospinal fluid (CSF) examination to diagnose pseudotumor cerebri. We therefore describe a patient whose condition would have been misdiagnosed if not for the CSF findings.
Report of a Case.
—A 23-year-old woman was admitted after three weeks of a bifrontal, nonthrobbing headache, nausea, and early-morning vomiting. Admission vital signs and findings on general examination were normal. There was bilateral papilledema with flame hemorrhages and, on formal visual field testing, enlarged blind spots. Visual acuity was 20/20
Emery JM, Healton EB, Brust JCM. Pseudopseudotumor. Arch Neurol. 1986;43(8):757. doi:10.1001/archneur.1986.00520080009009