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[Idiopathic intracranial hypertension in childhood]
J Sierra-Rodríguez1, P Martín-Muñoz
1Servicio de Pediatría, Hospital Juan Ramón Jiménez, Huelva, España.
Insights
Idiopathic intracranial hypertension (IIH) in children shows a favorable prognosis, especially in infants. Treatment varies by age, with infants responding to fluid restriction and older children benefiting from corticosteroids alongside other therapies.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Neurosurgery
Context:
- Idiopathic intracranial hypertension (IIH) is a rare but serious condition in children.
- Understanding IIH in pediatric populations is crucial for timely diagnosis and management.
- This study reviews 14 cases of IIH in children over 15 years.
Purpose:
- To analyze the clinical features, diagnostic methods, and treatment outcomes of pediatric IIH.
- To compare IIH presentation and management in children under and over 24 months.
- To identify potential etiological factors in pediatric IIH.
Summary:
- Diagnosis involved modified Ahlskog criteria, including CSF pressure and neuro-imaging.
- Infants (under 24 months) presented with irritability and bulging fontanelle, treated with fluid restriction.
- Older children (over 24 months) experienced headache, vomiting, and diplopia, requiring corticosteroids for recovery.
Impact:
- Highlights the generally favorable prognosis of IIH in children, particularly infants.
- Demonstrates age-dependent differences in IIH presentation and treatment response.
- Emphasizes the importance of age-specific management strategies for pediatric IIH.
Introduction:
We present the cases of idiopathic, intracranial hypertension (HII) in children studied in our hospital over the past 15 years (14 cases), reviewing the clinical features, complementary tests, associated causes, treatment and evolution.
Patients And Methods:
Diagnosis of HII was based on a modification of Ahlskog's criteria (1982) (the child was sedated to avoid increased cranial pressure due to crying): no focal signs, CSF pressure greater than 200 mm of H2O, normal composition of CSF and normal neuro-imaging findings. Two groups were established according to age. The first group included those under 24 months old and the second group those over 24 months. Differences were seen in the presenting, symptoms, neurological examination and treatment.
Results:
In the first group the cause of consultation was irritability and a bulging fontanelle. They recovered after simply restricting fluids and treating the associated cause. In the second group, consultation was for headache and vomiting, and sometimes diplopia also. Recovery was satisfactory (except in one case) when corticosteroids were added to the above treatment. The complementary tests carried out depended on the clinical history, general and neurological examination and associated cause (MR, vitamin A levels, nutritional index, etc.). A possible aetiological relationship was found in 75% of cases.
Conclusions:
We emphasize the favourable course and good prognosis of HII in infants as compared to adults.