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February 1987

Controversies in Diagnosis and Management of Pseudotumor Cerebri-Reply

Author Affiliations

Hospital for Sick Children 555 University Ave Toronto, Ontario, Canada M5G 1X8

Arch Neurol. 1987;44(2):129. doi:10.1001/archneur.1987.00520140005004

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In Reply.  —I fully agree with T. J. Carlow et al in their statement that intracranial pressure (ICP) monitoring is not a diagnostic test for pseudotumor cerebri. Pseudotumor cerebri is a condition that is diagnosed clinically and supplemented by neuroradiologic investigation.However, we all recognize that ICP varies greatly in patients with pseudotumor cerebri. A single lumbar puncture does not reflect what levels of ICP the patient actually endures. Only with continuous ICP recording, particularly during rapid eye movement (REM) sleep, can one reliably gauge the patient's state of ICP. Normal ICP during REM sleep should never go above 15 mm Hg. In young children, it rarely goes above 10 mm Hg, and in infants, above 6 mm Hg.The authors quote a study stating that headaches in patients with pseudotumor cerebri do not occur during pressure plateaus. I would agree, in that in our patient population with pseudotumor cerebri pressures were

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