Presentation Of Idiopathic Intracranial Hypertension Research Articles

Presentation, investigation and management of idiopathic intracranial hypertension in children

Summary Idiopathic intracranial hypertension is characterised by increased intracranial pressure in the presence of normal cerebrospinal fluid, normal neuroimaging and no localising signs on neurologic exam except cranial nerve VI palsy. It is common in adults, particularly obese young women, but also occurs in children and adolescents. We discuss the clinical presentation of idiopathic intracranial hypertension in the pediatric population and how the presenting signs and symptoms may be different from those seen in adult patients. We discuss the differential diagnosis for idiopathic intracranial hypertension, as well as underlying conditions that may be associated with it. As in adults, therapy most often involves the use of carbonic anhydrase inhibitors, diuretics, and steroids. Children with vision loss due to idiopathic intracranial hypertension who not respond to aggressive medical therapy should be promptly referred for surgical intervention, including optic nerve fenestration and cerebrospinal (CSF) shunting procedures such as ventriculoperitoneal or lumboperitoneal shunting.

Shunt failure in idiopathic intracranial hypertension presenting with spontaneous cerebrospinal fluid leak

A case of spontaneous cerebrospinal (CSF) fluid leak after ventriculoperitoneal shunt (VPS) failure in a patient with idiopathic intracranial hypertension (IIH) is reported. This is the first report of spontaneous CSF leak in an IIH patient without a history of trauma, sinus surgery, or intracranial surgery. The diagnosis was confirmed using thin-sliced post-contrast computed tomography, which revealed a micro-dehiscence of the cribiform plate at the superior aspect of the ethmoid sinus. The patient underwent VPS revision without complication, resulting in complete amelioration of symptoms and cessation of CSF rhinorrhoea at 1 year follow up.

Idiopathic Intracranial Hypertension Presenting With Psychiatric Symptoms

Idiopathic Intracranial Hypertension Presenting With Psychiatric Symptoms

Idiopathic Intracranial Hypertension Presenting With Psychiatric Symptoms

Idiopathic Intracranial Hypertension Presenting With Psychiatric Symptoms

Idiopathic intracranial hypertension presenting as hemiplegic migraine

A 14‐y‐old girl presented with a 2 h history of left hemiplegia preceded by mild left‐sided sensory disturbance. She had experienced migraines for several years and there was a strong family history of migraine, including hemiplegic migraine in one of her sisters. Her hemiplegia and headache responded to sumatriptan but her headache and vomiting subsequently returned. She was found to have intracranial hypertension and developed papilloedema and paracentral scotomas. Further history revealed she had been taking minocycline for acne. Conclusion: An association between hemiplegic migraine and pseudotumour cerebri has not previously been reported. There may be a case for examining patients with pseudotumour cerebri for the calcium channel mutation (CACNA1A).

Idiopathic intracranial hypertension in children.

We studied prospectively the etiology, clinical presentation, and outcome of idiopathic intracranial hypertension in 36 patients (20 boys and 16 girls) aged 3.5 months to 14 years. The etiology was identified in 28 (77.7%) patients. The most common predisposing factor was middle-ear infection, followed by obesity. Of the 36 cases seen, 26 presented with the classic picture of headaches, papilledema, and elevated cerebrospinal fluid pressure; 8 children had intracranial hypertension in the absence of papilledema and 2 had fundoscopic evidence of papilledema with normal cerebrospinal fluid pressure initially. In four children resolution of intracranial hypertension occurred with removal of the causative agent or appropriate treatment of the underlying condition. In 8 of 17 patients intracranial hypertension resolved with acetazolamide therapy and in 22 of 24 patients it resolved with corticosteroids in combination with acetazolamide. Subnormal visual acuity, narrowing of visual fields, or both were present on the initial examination in 10 patients; 2 of them, who presented with loss of vision, have permanent visual impairment. Four additional patients presented a transient, mild impairment of visual acuity during treatment. Our study confirms the wide clinical spectrum and the difficulties encountered in diagnosis of idiopathic intracranial hypertension. A wide variety of etiologic associations should be investigated to provide definitive therapy. Loss of visual function is the only serious complication.

Emergency department presentation of idiopathic intracranial hypertension

Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is a syndrome characterized by an elevated intracranial pressure in the absence of a focal lesion, infective process, or hydrocephalus. New onset IIH may present to the emergency department in a variety of ways. To describe the etiologic associations and clinical features in this disorder, we performed a retrospective analysis of consecutive emergency department patients with new onset IIH during the calendar years 1987–1996. A total of 52 patients met all study criteria. The mean patient age was 27 ± 8.9 years; the female-to-male ratio was 7:1. An etiologic association could be identified in 85% of cases and included obesity, hypertension, drugs, endocrine, and systemic disorders. Headache was a dominant complaint in most patients ( 48 52 ) and associated with dizziness, nausea, and/or visual complaints. Fourteen patients (27%) were not diagnosed on their initial ED visit and were more likely to have atypical clinical features (71% vs. 24%; P = .004). Atypical features included paraesthesias, neck/back pain, unilateral headache, vertigo, and nystagmus. Papilledema, the ophthalmoscopic hallmark of IIH, was not detected initially in 11 patients (21%). These results suggest that IIH is a relatively uncommon neurological illness that may have a variety of causes. The emergency department diagnosis may be complicated by atypical clinical features and a lack of detectable papilledema.