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Treatment of visual loss in pseudotumor cerebri associated with uremia

Departments of Ophthalmology (Dr. Guy), Neurology (Dr. Guy), and Neurosurgery (Dr. Day), University of Florida, Gainesville, FL; the Departments of Neurology and Ophthalmology (Drs. Johnston and Corbett), University of Iowa, Iowa City, IA; and the Bascom Palmer Eye Institute (Dr. Glaser), Miami, FL.

Ten patients with pseudotumor cerebri associated with renal insufficiency had papilledema and elevated intracranial pressure, but neurologic examinations and CT were normal. The 40% frequency of severe visual loss, 20/100 or worse, was higher than expected for pseudotumor cerebri. While furosemide was effective in 3 patients with renal transplants, administration of corticosteroids to 2 other patients did not halt progressive loss of vision. The visual function of 2 patients deteriorated even after lumboperitoneal shunting. Five patients underwent fenestration of the optic nerve sheath. This procedure improved the visual acuity of 3 patients and stabilized vision in the others. While the pathogenesis of pseudotumor cerebri in renal insufficiency is unknown, optic nerve sheath fenestration is the surgical treatment of choice for visual loss unresponsive to medical therapy.

Address correspondence and reprint requests to Dr. John Guy, Neuro-Ophthalmology Service, JHMHC Box J-284, University of Florida, College of Medicine Gainesville, FL 32610.

Supported in part by an unrestricted departmental grant from Research to Prevent Blindness, Inc. (Universities of Florida and Iowa) and by grant RR00059 from the General Clinical Research Center Branch of the National Institutes of Health (University of Iowa).

Presented in part at the 39th annual meeting of the American Academy of Neurology, New York, NY, April 1987.

Received April 28,1989. Accepted for publication in final form June 16, 1989.

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