title: Idiopathic intracranial hypertension in children: Diagnostic and management approach.
abstract: Idiopathic intracranial hypertension (IIH) is a rare neurological disorder in children. It is characterized by raised intracranial pressure (ICP) in the absence of brain parenchymal lesion, vascular malformations, hydrocephalus, or central nervous system (CNS) infection. The diagnosis is usually confirmed by high opening pressure of cerebrospinal fluid (CSF) with exclusion of secondary causes of intracranial hypertension. If not treated properly, it may lead to severe visual dysfunction. Here we review the etiology, clinical presentation, diagnostic criteria and management of IIH in children through illustration of the clinical and radiological presentation of a 13-year-old overweight girl who presented with severe headache, diplopia and bilateral papilledema. Otherwise, she had unremarkable neurological and systemic examinations. Lumbar puncture showed a high CSF opening pressure (360-540 mmH2O). Her investigations showed normal complete blood count (CBC), normal renal, liver, and thyroid function tests. Cerebrospinal fluid (CSF) and blood chemistry were unremarkable. Magnetic resonant image (MRI) of the brain demonstrated empty sella turcica, tortuous optic nerves, and flattening of the posterior sclera. Magnetic resonant venography (MRV) showed focal narrowing of the distal transverse sinuses and absence of venous sinus thrombosis. She required treatment with acetazolamide and prednisolone. With medical treatment, weight reduction, and exercise, our patient had a remarkable improvement in her symptoms with resolution of papilledema in two months. This review highlights the importance of early recognition and management of IIH to prevent permanent visual loss.
authors.affiliation: Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University , Riyadh , Saudi Arabia.
authors.forename: Abdulrahman
authors.initials: A
authors.lastname: Albakr
authors.affiliation: Division of Neurology, Departments of Pediatrics, King Khalid University Hospital, College of Medicine, King Saud University , Riyadh , Saudi Arabia.
authors.forename: Muddathir H
authors.initials: MH
authors.lastname: Hamad
authors.affiliation: Pediatric Neurology Department, National Neuroscience Institute , King Fahad Medical City, Riyadh , Saudi Arabia.
authors.forename: Ali H
authors.initials: AH
authors.lastname: Alwadei
authors.affiliation: Division of Neurology, Departments of Pediatrics, King Khalid University Hospital, College of Medicine, King Saud University , Riyadh , Saudi Arabia.
authors.forename: Fahad A
authors.initials: FA
authors.lastname: Bashiri
authors.affiliation: Department of Radiology, College of Medicine, King Saud University , Riyadh , Saudi Arabia.
authors.forename: Hamdy H
authors.initials: HH
authors.lastname: Hassan
authors.affiliation: Division of Neurology, Departments of Pediatrics, King Khalid University Hospital, College of Medicine, King Saud University , Riyadh , Saudi Arabia.
authors.forename: Hiyam
authors.initials: H
authors.lastname: Idris
authors.affiliation: Division of Neurology, Departments of Pediatrics, King Khalid University Hospital, College of Medicine, King Saud University , Riyadh , Saudi Arabia.
authors.forename: Saeed
authors.initials: S
authors.lastname: Hassan
authors.affiliation: Division of Neurology, College of Medicine, King Saud University , Riyadh , Saudi Arabia.
authors.forename: Taim
authors.initials: T
authors.lastname: Muayqil
authors.affiliation: Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud University , Riyadh , Saudi Arabia.
authors.forename: Ikhlass
authors.initials: I
authors.lastname: Altweijri
authors.affiliation: Division of Neurology, Departments of Pediatrics, King Khalid University Hospital, College of Medicine, King Saud University , Riyadh , Saudi Arabia.
authors.forename: Mustafa A
authors.initials: MA
authors.lastname: Salih
keywords: Child; Idiopathic intracranial hypertension; Primary intracranial hypertension; Pseudo tumor cerebri; Secondary intracranial hypertension