TREATMENT
■ Start immediately if diagnosis is suspected.
■ Prednisone 40–80 mg/day
■ NSAIDs for pain relief
COMPLICATIONS
Severe complication →loss of vision due to ischemic optic neuritis.
Pseudotumor Cerebri
A disease primarily of young obese females
PATHOPHYSIOLOGY
Pathophysiology is uncertain, but is linked to oral contraceptives, vitamin A,
chronic steroid use, tetracycline, and thyroid disorders.
SYMPTOMS/EXAM
■ Longstanding headache +/−visual disturbances
■ Visual loss may occur.
■ Eye findings may include papilledema,loss of peripheralvisionandCN
VI palsy.
DIAGNOSIS
■ Based on finding of increased intracranial pressure (>25 cm H 2 O) with
normal CSF evaluation
■ Head CT may show small ventricles and an enlarged cisterna magna.
TREATMENT
■ Aimed at lowering intracranial pressure
■ Acetazolamideor steroids to decrease the formation of CSF
■ Recurrent LP’s or shunt surgery for refractory cases
Internal Carotid and Vertebral Artery Dissection
The most frequent cause of stroke in patients <45 years, internal carotid and
vertebral artery dissection may be spontaneous or trauma related. Diagnosis is
challenging because early symptoms are often vague and nonspecific.
SYMPTOMS/EXAM
Internal carotid dissection:
■ Unilateral anterior neck pain or headache around the eye or frontal area,
classically abrupt in onset
■ Findings include ipsilateral Horner syndrome, contralateral stroke, or TIA
symptoms.
Vertebral artery dissection:
■ Marked occipital or posterior neck pain with signs of brainstem TIA or
stroke
NEUROLOGYTemporal arteritis and
pseudotumor cerebri may
both lead to loss of vision if
left untreated.Neck pain and neurologic
symptoms? Consider internal
carotid and vertebral artery
dissection.