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Idiopathic intracranial hypertension in childhood: pitfalls in diagnosis

Deepa Krishnakumar1, John D Pickard, Zofia Czosnyka

  • 1Department of Paediatric Neurology, Addenbrooke's Hospital, Cambridge, UK.

Developmental Medicine and Child Neurology
|May 24, 2014
PubMed

Insights

Misdiagnosis of idiopathic intracranial hypertension (IIH) in children is common. Accurate diagnosis requires expert ophthalmology, neuroradiology, and advanced cerebrospinal fluid pressure studies, not just standard lumbar puncture.

Area of Science:

  • Pediatric Neurology
  • Ophthalmology
  • Neuroradiology

Background:

  • Idiopathic intracranial hypertension (IIH) is often misdiagnosed in pediatric patients.
  • Accurate diagnosis is crucial for appropriate management and preventing long-term complications.

Purpose of the Study:

  • To identify the reasons for misdiagnosis of IIH in children referred to a tertiary neurology unit.
  • To improve diagnostic accuracy for pediatric IIH.

Main Methods:

  • Retrospective review of pediatric patients referred for suspected IIH with normal brain MRI over 4 years.
  • Confirmation of IIH through expert ophthalmology (including ultrasound/tomography) and advanced cerebrospinal fluid (CSF) pressure studies.

Main Results:

  • Six out of 15 referred children were diagnosed with IIH; all were overweight and over 10 years old.
  • Four children had IIH secondary to other causes.
  • Misdiagnoses included papilledema, drusen, and crowded discs; some had initially elevated CSF pressure on standard lumbar puncture but normal advanced studies.

Conclusions:

  • Frequent misdiagnosis of IIH in children can be reduced.
  • Recommendations include expert ophthalmological examination (fundoscopy, orbital ultrasound, OCT), expert neuroradiology, and steady-state CSF pressure assessment over standard opening pressure.
Abstract

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