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The Red-Flag Paradox of Clinical Signs Synonymous With Intracranial Hypertension in Children
Jeong A Kim1, Carol Park2, Moon Hee Hur2
1Department of Child and Adolescent Neurology, Nemours Children's Health, Jacksonville, Florida.
Insights
Intracranial hypertension (IH) in children can present with nonspecific symptoms. Positional headache and neck/shoulder pain may indicate IH, even paradoxical positional headaches.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Clinical Diagnostics
Background:
- Intracranial hypertension (IH) in children presents diagnostic challenges due to nonspecific symptoms.
- Identifying
- red-flag
- headache signs is crucial but their predictive value in pediatric IH is not well-established.
Purpose of the Study:
- To evaluate headache characteristics associated with
- red flags
- in children diagnosed with intracranial hypertension (IH).
Main Methods:
- Retrospective chart review of 78 pediatric patients undergoing lumbar puncture for IH evaluation.
- Analysis of headache characteristics, including positional variations and associated symptoms, in relation to confirmed IH diagnosis.
Main Results:
- Of 54 children with IH, 42 reported headaches. Worsening headache in the supine position occurred in 26% of IH patients.
- Paradoxical positional headache (worse when upright) was reported in 14% of IH patients.
- Neck and shoulder pain correlated with significantly higher opening pressure in the IH group (P < 0.01).
Conclusions:
- Positional headache is a key feature of pediatric IH, with paradoxical presentations also noted.
- Neck and shoulder pain should be recognized as potential indicators of IH in children.
- Larger studies are needed to further elucidate IH signs and symptoms in pediatric populations.
Background:
Intracranial hypertension (IH) is well-documented in children but remains challenging to clinicians because patients often present with nonspecific symptoms. Clinical features concerning for "red-flag signs" in headache could be representative of IH; however, the incidence or predictive value of these features is not well reported in children.
Methods:
We evaluated the headache characteristics concerning for "red flags" among children with IH syndrome. By retrospective chart review, a total of 78 patients who underwent lumbar puncture to evaluate IH were analyzed.
Results:
Among 78 patients, 54 had confirmed IH (37 primary, 17 secondary) and in 24 IH was ruled out. Forty-two of 54 patients with IH and 23 of 24 non-IH patients presented with headache. Eleven of these 42 with IH (26%) presenting with headache complained of worsening headache in the supine position, and four of the 23 non-IH (17%) complained of worsening headache in the supine position. There was paradoxical positional headache (worse when upright) reported in both the IH and non-IH groups as 14% (six of 42) and 13% (three of 23), respectively. Within the IH group was significantly higher opening pressure in patients with neck/shoulder pain compared with patients without pain (P < 0.01).
Conclusions:
Positional headache is an important clinical feature, but it should be considered that patients with IH can present with paradoxical positional headache. Neck and shoulder pain should be considered a symptom of IH as well. A larger cohort investigating IH in children to identify signs and symptoms will be helpful.
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