Pediatric idiopathic intracranial hypertension – Is the fixed threshold value of elevated LP opening pressure set too high?. (November 2017)

• Record Type: Journal Article
• Authors: Gerstl, Lucia; Schoppe, Nikola; Albers, Lucia; Ertl-Wagner, Birgit; Alperin, Noam; Ehrt, Oliver; Pomschar, Andreas; Landgraf, Mirjam N.; Heinen, Florian
• Is Part Of: European journal of paediatric neurology. Volume 21:Number 6(2017:Nov.)
• Page Start: 833
• Page End: 841
• Publication Date: 2017-11
• Subjects: Diagnostic criteria -- Children -- Venous ophthalmodynamometry -- MRI based measurement -- Pseudotumor cerebri syndrome; Pediatric neurology -- Periodicals; Nervous System Diseases -- Periodicals; Child -- Periodicals; Infant -- Periodicals; Neurologie pédiatrique -- Périodiques; Pediatric neurology; Electronic journals; Periodicals; Electronic journals; 618.928
• DOI: 10.1016/j.ejpn.2017.08.002
• Languages: English
• ISSNs: 1090-3798

Abstract

Abstract: Background: Idiopathic intracranial hypertension (IIH) in children is a rare condition of unknown etiology and various clinical presentations. The primary aim of this study was to evaluate if our pediatric IIH study group fulfilled the revised diagnostic criteria for IIH published in 2013, particularly with regard to clinical presentation and threshold value of an elevated lumbar puncture opening pressure. Additionally we investigated the potential utilization of MR-based and fundoscopic methods of estimating intracranial pressure for improved diagnosis. Patients and methods: Clinical data were collected retrospectively from twelve pediatric patients diagnosed with IIH between 2008 and 2012 and revised diagnostic criteria were applied. Comparison with non-invasive methods for measuring intracranial pressure, MRI-based measurement (MR-ICP) and venous ophthalmodynamometry was performed. Results: Only four of the twelve children (33%) fulfilled the revised diagnostic criteria for a definite diagnosis of IIH. Regarding noninvasive methods, MR-ICP (n = 6) showed a significantly higher mean of intracranial pressure compared to a healthy age- and sex-matched control group (p = 0.0043). Venous ophthalmodynamometry (n = 4) showed comparable results to invasive lumbar puncture. Conclusion: The revised diagnostic criteria for IIH may be too strict especially in children without papilledema. MR-ICP and venous ophthalmodynamometry are promising complementary procedures for monitoring disease progression and response to treatment. Highlights: In diagnosis of idiopathic intracranial hypertension in children an LP opening pressure range more than a strict cut-off value should be applied. Noninvasive measurements of intracranial pressure may be promising methods for monitoring disease progress.