Paediatric idiopathic intracranial hypertension

Abstract

Aim: Idiopathic intracranial hypertension usually occurs in adults. The purpose of this study was to review paediatric idiopathic intracranial hypertension and determine the specific characteristics and outcome of the paediatric condition compared with adult idiopathic intracranial hypertension. Methods: Thirteen case notes were retrospectively reviewed (11 females, 2 males). The average presenting age was 13.5 years (range 10-17 years). Diagnosis of idiopathic intracranial hypertension followed exclusion of other neurological causes. Each patient underwent lull ophthalmic, orthoptic and neurological evaluation. Results: Three patients were asymptomatic whereas the remainder presented with symptoms including headaches, visual disturbances, lethargy, vomiting and nausea. Each patient had papilloedema. Initial lumbar puncture opening pressures ranged from 160 to 790 mmH2O. Orthoptic findings included concomitant esotropia, sixth, third and fourth nerve palsies. Visual fields were impaired in 9 cases. Treatment included prednisolone, acetazolumide, lumbar peritoneal shunting and optic nerve sheath fenestration. Conclusions: Visual fields were impaired in 9 patients despite absence of visual symptoms in 3. Medical treatment was usual although 3 patients required lumbar peritoneal shunting and I required optic nerve sheath fenestration to arrest visual deterioration. The paediatric visual outcome of idiopathic intracranial hypertension reflects the adult condition. Paediatric patients require the same evaluation, follow-up and treatment regimes to optimise outcome.