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Treatment Most patients with idiopathic intracranial hypertension will be found initially to have minor visual changes aside from the papilledema; the headache and lumbar puncture pressure then guide treatment Besides symptomatic relief of headaches, the progression of visual loss mentioned above is the main concern At least one-quarter of our patients have recovered within 6 months after only repeated lumbar punctures and drainage of suf cient CSF to maintain the pressure at normal or near-normal levels (less than 200 mmH2O) The lumbar punctures were performed daily or on alternate days at rst and then at longer intervals, according to the level of pressure Evidently this was suf cient to restore the balance between CSF formation and absorption for at least several months At the same time, weight loss has been encouraged and the best results have been reported when this was successful.

.047 .05 .056 .068 .1 .2 .22 .33 .47 .56 1 2

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Having to solder the joint over again always increases the risk of applying too much heat to the PCB. As the solder solidifies, take a careful look at the joint you have made, to make sure there s a smooth and fairly shiny metal fillet around it. This should be broadly concave in shape, showing that the solder has formed a good bond to both metal surfaces. If it has a rough and dull surface or just forms a ball on the component lead, or a volcano on the PCB pad with the lead emerging from the crater, you have a dry joint. If your solder joint looks like the picture shown in Figure 3-11, you will have to re-solder the joint over again. Figure 3-12 shows another type of dry solder joint which would have to be re-soldered. These types of dry solder joints if now redone will cause the circuit to be unreliable and intermittent. For projects that use one or more integrated circuits, with their leads closely-spaced pins, you may find it easier to use a finer gauge solder, i.e. less than 1 mm in diameter. This reduces the risk of applying too much solder to each joint, and accidentaly forming bridges between pads to PC tracks.

Weight Reduction This is always advised but is dif cult to accomplish In two pathologically obese patients, we have resorted to surgical gastric plication, which had a bene cial effect on the pseudotumor but left the patient for a time with the severe gastrointestinal disturbances that commonly complicate this procedure Sugerman et al (1999) studied 24 morbidly obese women who had similar operations and found the results to be satisfactory over several years Two of our patients developed a sensory polyneuropathy after surgery The use of gastric plication and related procedures is currently undergoing re-evaluation for obesity in general; but in the dire circumstances of psuedotumor with visual loss, it is probably a reasonable alternative Lumbar-Peritoneal Shunting In patients who are unresponsive to the usual therapeutic measures, one treatment method that may be considered is a lumbar-peritoneal shunt Only a few of our patients have undergone this surgical procedure.

Care must be taken to avoid inadvertent asymmetrical weakening of the depressor labii inferioris muscle, which can lead to an asymmetric smile. Other adverse effects include drooling or mouth incompetence and dif culty with speech.

There are three basic types of cards that you will construct in WML. M I L Choice card Display card Generally presents a set of menu options to the user. Requests data from the user for use within the application. Displays or presents the result data to the user. Data entry card

It has been relatively safe and effective, but because of a tendency for the shunt to become obstructed or to be dislodged in obese patients, sometimes causing back or sciatic pain, the procedure has fallen out of favor Burgett et al, who treated 30 patients in this way, reported success in reducing headache in almost all and in improving vision in 70 percent Despite its shortcomings, this procedure may be preferable to the optic nerve fenestration described below We have not had to resort to cranial subtemporal decompression, a procedure that was formerly used when vision was threatened Corticosteroids Prednisone (40 to 60 mg/day), oral hyperosmotic agents such as glycerol (15 to 60 mg four to six times daily), or carbonic anhydrase inhibitors (acetazolamide 500 mg twice or thrice daily; furosemide 20 to 80 mg twice daily) to reduce CSF formation all have their advocates.

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We have occasionally observed a gradual recession of papilledema and a lowering of CSF pressure.

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