How to know

…when your patient realy has pseudotumor cerebri:

Doctor says: we need to do a lumbar puncture.

Patient says: Oh, thank god, and isn’t at all sarcastic.



  1. Hi, Doc. Many of us with treated and untreated Cushing’s also deal with idiopathic intracranial hypertension (IIH)(aka pseudotumor cerebri) which is actually “treated” by the Cushing’s. (This is well documented in literature/research.) Many deal with a shunt rather than take steroids because that leads to Cushing’s all over again. So, this patient’s relief is very well understood. Since we do have some folks in your area, it could very well be one of them. I sure hope s/he feels better soon. Thanks for taking care of him/her.

  2. Back when I worked on the floor I had a patient whose drug-seeking story was that she had pseudotumor cerebri and her VP shunt was malfunctioning. She was from out of town and came in every holiday with the same story. She’d come in and demand to be “tapped” and, oh, BTW, I need like 2 mg dilaudid IVP with a benadryl chaser for this awful pain Q2hrs. She’d throw in “I’m going blind, I’m going blind! I need more drugs” in there too. Short story is that the VP shunt was always working fine and there was no excess pressure build-up when they did the LPs.

    So, in short, if you’re an addict, you’ll do anything for drugs.

  3. Hm, come to think of it…holiday…pseudotumor cerebri…happy about an LP…wonder if her family moved to DFW.

  4. I diagnose one of those about every now and again… last one was about a month ago.

  5. Nurse K, I hope you never have one of those headaches. It could make an addict of anyone. Most folks don’t want a LP for any reason unless it is the lesser of the two evilspains.

  6. Robin, I hope you never have to be that woman’s nurse. I’d prefer a headache over that any day.

  7. Nurse K, be careful what you wish for. I once had a headache that lasted three f****g years.

    I have a stupid sinus headache today (rare) and I’m trying hard not to whine, and also wondering how I didn’t freaking kill myself during those 36 months. Holy crap!

  8. I have a good friend who unfortuantely has communicating hydocephalus and had a series of LPs to determine if he would have any improvement with a shunt. After the second LP he could not wait for the shunt. His neurologic symptoms improved but the headache nearly killed him. He said the headache was worth it though to have control of his body again.

  9. I had a psuedotumor cerebri and STILL didn’t want anything to do with an LP.

  10. I had an episode of psuedotumor cerebri, omg was that LP the best thing ever. I’d had a head ache for about a month, but didn’t realize anything was up until I started having vision black outs, didn’t want to go to the hospital cause of no insurance. Luckily I did I still have some residual vision damage from the swelling. I scared the poor guy who did my LP, he’d never seen the fluid overflow the tube and splash onto the floor let alone then have me thank him for it. I didn’t get a headache afterwards but I believe it’s because they had me take a pain pill (big horse sized thing) before they started then I didn’t move for an hour.