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Pediatric Intracranial Hypertension
Shawn C Aylward1, Rachel E Reem2
1Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Idiopathic intracranial hypertension (IIH) in children is not rare, with headache being a key symptom. Treatment focuses on weight loss and medication, though some patients develop chronic headaches post-resolution.
Area of Science:
- Neurology
- Pediatrics
- Ophthalmology
Background:
- Idiopathic intracranial hypertension (IIH) is increasingly recognized in pediatric populations.
- Accurate pediatric incidence data in the United States are lacking.
- Diagnostic criteria have evolved, adapting adult standards for children.
Purpose of the Study:
- To review the current understanding of pediatric idiopathic intracranial hypertension.
- To highlight diagnostic challenges and clinical presentations across different age groups.
- To outline current treatment strategies and potential complications.
Main Methods:
- Review of existing literature on pediatric idiopathic intracranial hypertension.
- Analysis of clinical presentations, diagnostic criteria, and treatment outcomes.
- Discussion of age-specific variations in symptomatology.
Main Results:
- Clinical presentation of IIH varies significantly with age, often subtle in younger children.
- Optic disc edema is a common incidental finding in prepubertal children.
- Headache is the most consistent symptom, accompanied by nausea, vomiting, tinnitus, and diplopia.
Conclusions:
- Weight loss and acetazolamide are primary treatments for pediatric IIH.
- Furosemide may enhance acetazolamide's efficacy.
- Surgical options like optic nerve fenestration and CSF shunting are reserved for refractory cases.
- Aggressive management is crucial to prevent vision loss and manage pain.
- A significant proportion of patients experience new or chronic headaches after initial recovery.
Abstract:
Primary (idiopathic) intracranial hypertension has been considered to be a rare entity, but with no precise estimates of the pediatric incidence in the United States. There have been attempts to revise the criteria over the years and adapt the adult criteria for use in pediatrics. The clinical presentation varies with age, and symptoms tending to be less obvious in younger individuals. In the prepubertal population, incidentally discovered optic disc edema is relatively common. By far the most consistent symptom is headache; other symptoms include nausea, vomiting tinnitus, and diplopia. Treatment mainstays include weight loss when appropriate and acetazolamide. Furosemide may exhibit a synergistic benefit when used in conjunction with acetazolamide. Surgical interventions are required relatively infrequently, but include optic nerve sheath fenestration and cerebrospinal fluid shunting. Pain and permanent vision loss are the two major complications of this disorder and these manifestations justify aggressive treatment. Once intracranial hypertension has resolved, up to two thirds of patients develop a new or chronic headache type that is different from their initial presenting headache.
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