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Behavioural Neurology
Volume 24 (2011), Issue 2, Pages 143-148

Cognitive Impairment in Patients with Pseudotumor Cerebri Syndrome

Siddharth Kharkar,1,2,3 Robert hernandez,2,3 Sachin Batra,2,3 Philippe Metellus,2 Argye Hillis,1,3 Michael A. Williams,1,3 and Daniele Rigamonti2,3

1Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
2Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
3Adult Hydrocephalus Program, Johns Hopkins Hospital, Baltimore, MD, USA

Received 20 May 2011; Accepted 20 May 2011

Copyright © 2011 Hindawi Publishing Corporation and the authors. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Introduction: Patients with Pseudotumor Cerebri Syndrome (PTCS) may complain of difficulty in thinking or concentrating; however there has been little formal cognitive evaluation in this population.

Objective: To evaluate the characteristics and nature of cognitive impairment in patients with PTCS.

Methods: We retrospectively reviewed records of 10 patients diagnosed with PTCS who were cognitively tested at presentation. In each cognitive test, “Borderline deficit” (BD) was defined as a score more than 1 standard deviation (SD) below and “Definite Deficit” (DD) as a score more than 2 SD below the mean for age, sex and education. In each cognitive domain, impairment was defined as a single test score more than 2 SD below the mean, or scores of more than 1 SD below the mean for age, sex and education in > 50% of tests.

Results: Mean age of patients was 43.4 ± 13.5 years. 8/10(80%) patients were female. 3/10(30%) had papilledema; 3/10(30%) had significant cerebral venous outflow obstruction. Impairment was most commonly seen and was most severe in the WMS logical memory I (BD44%, DD44%), WMS logical memory II (BD37.5%, DD50%), RAVLT delayed recall (BD30%, DD40%) and RAVLT retention(BD40%, DD30%) tests. Evaluation of cognitive domains revealed impairment in memory and learning (80%), executive function (10%), visuospatial skills (30%), and language (30%).

Conclusion: Our results indicate that patients with PTCS can have significant cognitive impairment, particularly in learning and memory. The prevalence needs to be studied in a larger cohort. The relationship of cognitive impairment with chronically elevated intracranial pressures and its role in contributing to patient morbidity needs to be investigated further.