Intracranial Hypertension Without Papilledema in Children

Area of Science:

• Pediatric Neurology
• Ophthalmology
• Neuroscience

Background:

• Intracranial hypertension (IH) is a condition characterized by elevated pressure within the skull.
• Papilledema, or optic nerve edema, is a common sign of IH, but its absence does not rule out the condition.
• Diagnosing IH without papilledema in children presents diagnostic challenges.

Purpose of the Study:

• To determine the frequency of intracranial hypertension without papilledema in a pediatric population.
• To identify clinical characteristics associated with IH in the absence of optic nerve edema.
• To evaluate the diagnostic utility of headache as a sole presenting symptom of IH in children.

Main Methods:

• Retrospective chart review of patients evaluated at a pediatric IH clinic.
• Categorization of patients into groups based on the presence or absence of optic nerve edema.
• Statistical comparison of age, body mass index, and cerebrospinal fluid opening pressure between groups using the Wilcoxon rank sum test.

Main Results:

• A total of 228 charts were reviewed, with 152 patients meeting criteria for IH.
• 27 patients (17.8%) were diagnosed with IH presenting with headache but without optic nerve edema.
• No significant differences were observed in age, BMI, or opening CSF pressure between the groups.

Conclusions:

• A notable proportion of pediatric patients with intracranial hypertension may present without optic nerve edema.
• Headache can be a key symptom of IH in children, even in the absence of visible optic nerve swelling.
• Further investigation is warranted for children with persistent headaches suggestive of IH, regardless of funduscopic findings.