title: Viral-induced intracranial hypertension mimicking pseudotumor cerebri.
abstract: BACKGROUND
  Pseudotumor cerebri or idiopathic intracranial hypertension is characterized by normal spinal fluid composition and increased intracranial pressure in the absence of a space-occupying lesion.
  
  
  METHODS
  This study describes a subgroup of 10 patients with the same typical presenting symptoms (headache, vomiting, and papilledema) but without nuchal rigidity, meningeal signs, or change in mental status. Patients had normal neuroimaging studies and intracranial hypertension but also pleocytosis in the cerebrospinal fluid, suggesting central nervous system infection. From the results it can be hypothesized that those children represent a unique subgroup of viral-induced intracranial hypertension when comparing their risk factors, clinical course, treatment, and outcome with 58 patients who had idiopathic intracranial hypertension.
  
  
  RESULTS
  All patients with viral-induced intracranial hypertension presented with papilledema but none had reduced visual acuity or abnormal visual fields, compared with 20.7% of patients who had idiopathic intracranial hypertension. They also responded better to treatment with acetazolamide, needed a shorter duration of treatment (7.7 ± 2.6 months vs 12.2 ± 6.3 months, P = 0.03), and had no recurrences.
  
  
  CONCLUSIONS
  The results suggest that children who fulfill the typical presenting signs and symptoms and all diagnostic criteria for pseudotumor cerebri other than the normal cerebrospinal fluid component may represent a unique subgroup of viral-induced intracranial hypertension and should be managed accordingly. The overall prognosis is excellent.
authors.affiliation: Meyer Children's Hospital, Rambam Health Care Campus, Haifa, Israel. s_ravid@rambam.health.gov.il
authors.forename: Sarit
authors.initials: S
authors.lastname: Ravid
authors.forename: Yael
authors.initials: Y
authors.lastname: Shachor-Meyouhas
authors.forename: Eli
authors.initials: E
authors.lastname: Shahar
authors.forename: Zipi
authors.initials: Z
authors.lastname: Kra-Oz
authors.forename: Imad
authors.initials: I
authors.lastname: Kassis
mesh_terms: D000086:Acetazolamide / Q000627:therapeutic use; D000293:Adolescent; D000927:Anticonvulsants / Q000627:therapeutic use; D020805:Central Nervous System Viral Diseases / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D019586:Intracranial Hypertension / Q000150:complications / Q000188:drug therapy / Q000821:virology; D008297:Male; D010211:Papilledema / Q000150:complications / Q000188:drug therapy / Q000821:virology; D011559:Pseudotumor Cerebri / Q000503:physiopathology*; D012189:Retrospective Studies; D014792:Visual Acuity / Q000187:drug effects / Q000502:physiology
chemical_list: D000927:Anticonvulsants; D000086:Acetazolamide