title: Clinical characterization of idiopathic intracranial hypertension in children presenting to the emergency department: the experience of a large tertiary care pediatric hospital.
abstract: BACKGROUND
  Idiopathic intracranial hypertension (IIH) is a syndrome characterized by elevated intracranial pressure, without evidence of intracranial mass lesion or venous thrombosis on brain imaging. The syndrome occurs mainly in young, fertile, and overweight women but may present in any age group. The aim of this study was to report the presentation, course, and outcomes of older versus younger children presenting with IIH to the emergency department of our large tertiary care hospital during an 8-year period.
  
  
  METHODS
  Retrospective chart review (January 2000-December 2008) of all patients younger than 17 years with IIH was performed on the basis of modified Dandy Criteria. The patients were analyzed according to age (<11 years and 11-17 years) and weight centile (<90%, 90%-97%, >97%).
  
  
  RESULTS
  Ages ranged from 2 to 16.5 years (mean [SD], 9.71 [4.56] years). Thirty males (46.8%) and 33 females (53.2%) were identified: 30 were prepubertal with a male-female ratio of 1:0.56 and 33 were pubertal with a male-female ratio of 1:2 (P < 0.05). There were no significant differences between the 2 age groups in proportions of children in the 3 predefined weight categories The most common presenting symptom was headache (75%), which was significantly less common in the younger age group compared with the older group (P < 0.01). Papilledema was present in 51 patients (82.3%). Mean (SD) cerebrospinal fluid opening pressure was 378 (16) mm H2O. Findings of brain imaging (mostly computed tomographic scan), performed in all patients, were normal in 42 (67.7%); the most common finding in the remainder was swelling of the optic nerves.
  
  
  CONCLUSIONS
  Our results indicate that IIH should be considered in any child with new-onset headache or visual disturbance, irrespective of age, sex, weight, or the presence of known predisposing factors. When IIH is suspected, neuroimaging should be performed promptly to exclude secondary causes of this condition because IIH in children remains a diagnosis of exclusion. Early diagnosis and prompt treatment for IIH can prevent potential visual loss.
authors.affiliation: From the Divisions of *Pediatric Emergency Medicine, and †Pediatric Medicine, Department of Pediatrics, Dana-Dwek Children's Hospital, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; and Divisions of ‡Paediatric Emergency Medicine, and §Clinical Pharmacology and Toxicology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Miguel M
authors.initials: MM
authors.lastname: Glatstein
authors.forename: Asaf
authors.initials: A
authors.lastname: Oren
authors.forename: Gil
authors.initials: G
authors.lastname: Amarilyio
authors.forename: Dennis
authors.initials: D
authors.lastname: Scolnik
authors.forename: Amir Ben
authors.initials: AB
authors.lastname: Tov
authors.forename: Aiala
authors.initials: A
authors.lastname: Yahav
authors.forename: Arik
authors.initials: A
authors.lastname: Alper
authors.forename: Shimon
authors.initials: S
authors.lastname: Reif
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011559:Pseudotumor Cerebri / Q000150:complications / Q000175:diagnosis*; D012189:Retrospective Studies; D063128:Tertiary Health Care