Pediatric idiopathic intracranial hypertension – Is the fixed threshold value of elevated LP opening pressure set too high?

Lucia Gerstl, Nikola Schoppe, Lucia Albers, Birgit Ertl-Wagner, Noam Alperin, Oliver Ehrt, Andreas Pomschar, Mirjam N. Landgraf, Florian Heinen

Research output: Contribution to journalArticle

11 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)833-841
Number of pages9
JournalEuropean Journal of Paediatric Neurology
Volume21
Issue number6
DOIs
StatePublished - Nov 1 2017

Keywords

  • Children
  • Diagnostic criteria
  • MRI based measurement
  • Pseudotumor cerebri syndrome
  • Venous ophthalmodynamometry

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

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