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Asymptomatic idiopathic intracranial hypertension in young children
1Department of Neurology, Albany Medical College, New York 12208, USA. weigs@mail.amc.edu
Insights
Idiopathic intracranial hypertension can be asymptomatic in young children. Papilledema progression in asymptomatic youth necessitates further investigation for increased intracranial pressure.
Area of Science:
- Pediatric Ophthalmology
- Neurology
- Neurosurgery
Background:
- Idiopathic intracranial hypertension (IIH) symptoms vary by age, with older children reporting headaches and visual disturbances, while younger children may exhibit irritability.
- Diagnosing IIH in young children is challenging due to atypical or absent presenting symptoms.
Observation:
- This report details three young children who were asymptomatic but diagnosed with papilledema during routine eye exams.
- Initial cranial neuroimaging was negative, yet papilledema progressed in all three cases.
- Lumbar puncture revealed elevated cerebrospinal fluid pressure in all patients.
Findings:
- Two children were diagnosed with idiopathic intracranial hypertension, while the third had jugular venous obstruction.
- Papilledema in all three cases responded to acetazolamide or furosemide treatment.
- These cases highlight that asymptomatic presentation does not exclude increased intracranial pressure in pediatric patients.
Implications:
- Asymptomatic papilledema in young children warrants thorough evaluation for increased intracranial pressure.
- Early detection and management of pediatric intracranial hypertension are crucial to prevent long-term complications.
- This study underscores the importance of routine ophthalmic examinations in identifying potentially silent neurological conditions in children.
Abstract:
Presenting symptoms of idiopathic intracranial hypertension are known to vary with age. Older children may complain of headache, neck pain, diplopia, intracranial noises, or transient visual obscurations. Younger children may present with apathy or irritability. This report describes three young children with no obvious relevant symptoms in whom papilledema was newly found on routine follow-up eye examination for unrelated problems. At presentation, all had early papilledema with negative cranial neuroimaging studies. All remained apparently asymptomatic, but the papilledema progressed. Sedated lumbar puncture showed elevated cerebrospinal fluid pressure in all three. Two were felt to have truly idiopathic intracranial hypertension, whereas the third had jugular venous obstruction. The papilledema responded to treatment with either acetazolamide or furosemide in all three. An apparent lack of symptoms does not rule out chronic increased intracranial pressure in young children.