Pediatric idiopathic intracranial hypertension - Is the fixed threshold value of elevated LP opening pressure set too high?
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Published on: March 26, 2019
Lucia Gerstl1, Nikola Schoppe2, Lucia Albers3
1Department of Pediatric Neurology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
Insights
Revised diagnostic criteria for pediatric idiopathic intracranial hypertension (IIH) may be too strict. Non-invasive methods like MR-ICP show promise for monitoring IIH in children.
Area of Science:
- Pediatric Neurology
- Neuro-ophthalmology
Background:
- Idiopathic intracranial hypertension (IIH) in children is rare with unknown causes and varied presentations.
- The 2013 revised diagnostic criteria for IIH were evaluated in a pediatric cohort.
- Non-invasive methods for intracranial pressure estimation were explored.
Purpose of the Study:
- To assess if a pediatric IIH cohort meets revised 2013 diagnostic criteria.
- To evaluate clinical presentation and lumbar puncture opening pressure thresholds in pediatric IIH.
- To investigate MR-based (MR-ICP) and fundoscopic methods for intracranial pressure estimation.
Main Methods:
- Retrospective analysis of clinical data from twelve pediatric IIH patients (2008-2012).
- Application of the revised 2013 IIH diagnostic criteria.
- Comparison of invasive lumbar puncture with non-invasive MR-ICP and venous ophthalmodynamometry.
Main Results:
- Only 33% of pediatric patients met the revised IIH diagnostic criteria.
- MR-ICP showed significantly higher intracranial pressure in patients versus controls (p=0.0043).
- Venous ophthalmodynamometry results correlated with invasive lumbar puncture findings.
Conclusions:
- The revised IIH diagnostic criteria may be overly stringent for pediatric cases, particularly those without papilledema.
- MR-ICP and venous ophthalmodynamometry are valuable tools for monitoring IIH progression and treatment response in children.
Background:
Idiopathic intracranial hypertension (IIH) in children is a rare condition of unknown etiology and various clinical presentations. The primary aim of this study was to evaluate if our pediatric IIH study group fulfilled the revised diagnostic criteria for IIH published in 2013, particularly with regard to clinical presentation and threshold value of an elevated lumbar puncture opening pressure. Additionally we investigated the potential utilization of MR-based and fundoscopic methods of estimating intracranial pressure for improved diagnosis.
Patients And Methods:
Clinical data were collected retrospectively from twelve pediatric patients diagnosed with IIH between 2008 and 2012 and revised diagnostic criteria were applied. Comparison with non-invasive methods for measuring intracranial pressure, MRI-based measurement (MR-ICP) and venous ophthalmodynamometry was performed.
Results:
Only four of the twelve children (33%) fulfilled the revised diagnostic criteria for a definite diagnosis of IIH. Regarding noninvasive methods, MR-ICP (n = 6) showed a significantly higher mean of intracranial pressure compared to a healthy age- and sex-matched control group (p = 0.0043). Venous ophthalmodynamometry (n = 4) showed comparable results to invasive lumbar puncture.
Conclusion:
The revised diagnostic criteria for IIH may be too strict especially in children without papilledema. MR-ICP and venous ophthalmodynamometry are promising complementary procedures for monitoring disease progression and response to treatment.
