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High-dose methylprednisolone and acetazolamide for visual loss in pseudotumor cerebri
G T Liu1, J S Glaser, N J Schatz
1Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Florida.
Abstract:
We treated four patients who had acute, severe visual loss associated with pseudotumor cerebri with intravenous methylprednisolone (250 mg four times per day) for five days followed by an oral taper, in combination with acetazolamide and ranitidine. In addition to high-grade disk edema, one patient had serous detachment of both maculas and lipid deposition, one had a unilateral macular star, and one had a monocular branch retinal artery occlusion. These three patients experienced rapid and lasting improvement in visual acuity, visual field, papilledema, and symptoms. Vision of the fourth patient did not improve, requiring optic nerve sheath fenestration for chronic papilledema. Transient acne developed in one patient. This regimen is a safe, effective treatment of acute, severe visual loss associated with florid papilledema of pseudotumor cerebri. Lack of immediate improvement is an indication for optic nerve sheath decompression.
Insights
Intravenous methylprednisolone effectively treated severe vision loss in pseudotumor cerebri patients. Persistent papilledema despite treatment may necessitate optic nerve sheath fenestration.
Area of Science:
- Ophthalmology
- Neurology
Background:
- Pseudotumor cerebri (idiopathic intracranial hypertension) can cause severe visual loss.
- High-grade papilledema is a hallmark of this condition.
- Prompt treatment is crucial to prevent irreversible vision damage.
Observation:
- Four patients with acute, severe visual loss due to pseudotumor cerebri were treated.
- The treatment regimen included intravenous methylprednisolone, acetazolamide, and ranitidine.
- Ocular findings included high-grade disk edema, macular detachment, macular star, and retinal artery occlusion.
Findings:
- Three of four patients showed rapid and sustained improvement in visual acuity, visual fields, and papilledema.
- One patient did not respond to medical treatment and required optic nerve sheath fenestration.
- Transient acne was the only reported side effect.
Implications:
- This treatment regimen is a safe and effective option for acute, severe visual loss in pseudotumor cerebri.
- Lack of immediate response to this therapy suggests the need for surgical intervention, such as optic nerve sheath fenestration.
- Early intervention is key to preserving vision in patients with pseudotumor cerebri.