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[Benign intracranial hypertension: an unrecognized complication of corticosteroid therapy]
M Lorrot1, B Bader-Meunier, G Sébire
1Service de pédiatrie générale, hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Insights
Benign intracranial hypertension, a condition of increased intracranial pressure, can occur in children after corticosteroid reduction. Prompt diagnosis and treatment are crucial to prevent permanent vision loss.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Endocrinology
Background:
- Benign intracranial hypertension (BIH) involves elevated intracranial pressure of unknown etiology.
- BIH presents with varied symptoms, complications, and associations with other medical conditions.
Observation:
- A 6-year-old girl experienced BIH symptoms after oral corticosteroid dose reduction.
- Diagnostic workup, including CT scans, was normal, but bilateral papilledema and elevated cerebrospinal fluid pressure confirmed BIH.
- The patient was treated with prednisone, acetazolamide, and cerebrospinal fluid removal.
Findings:
- The therapeutic intervention led to complete resolution of BIH symptoms.
- The child experienced no further visual impairment after treatment.
Implications:
- BIH is an underrecognized complication in children, carrying a risk of permanent visual deficits.
- Ophthalmoscopic examination is recommended for children on high-dose corticosteroids presenting with headache or blurred vision, especially after dosage changes.
Background:
Benign intracranial hypertension is due to an increased intracranial pressure of unknown cause. The initial symptoms, complications and associations with medical conditions are discussed.
Case Report:
A 6-year-old girl developed symptoms of benign intracranial hypertension following reduction of oral corticosteroid therapy. Laboratory studies and head-computed tomographic scan were normal. Examination of the optic discs showed bilateral papilledema and the cerebrospinal fluid pressure was increased. The patient was given prednisone therapy 1 mg/kg daily initially, associated with acetazolamide, and removal of 25 mL of cerebrospinal fluid. All the symptoms resolved and the treatment was gradually decreased. The child developed no further visual failure.
Conclusion:
Benign intracranial hypertension with the risk of permanent visual loss is a complication underrecognized in children. All patients receiving large doses of the corticosteroids who complain of headache or blurring vision, particularly following a reduction of corticosteroid dosage, should have an ophtalmoscopic examination to exclude this complication.