ORIGINAL ARTICLE

Clinical Characterization of Idiopathic Intracranial Hypertension in Children Presenting to the Emergency Department The Experience of a Large Tertiary Care Pediatric Hospital Miguel M. Glatstein, MD,* Asaf Oren, MD,† Gil Amarilyio, MD,† Dennis Scolnik, MB, ChB,‡§ Amir Ben Tov, MD,† Aiala Yahav, MD,† Arik Alper, MD,† and Shimon Reif, MD†

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250 mm H2O, normal neuroimaging (apart from small ventricles found in some cases), and normal cerebrospinal fluid (CSF) content.1 The monikers benign intracranial hypertension and pseudotumor cerebri are no longer used because IIH has the potential to cause significant visual loss and to disrupt normal life. Intracranial or medullary expansive lesions should always be ruled out before the diagnosis is made.2 With an incidence of 1 in 100,000 in the general population, IIH is uncommon in children. Although the pathophysiological mechanisms leading to this condition are unclear and the causes are not the same in children and adults,3 several factors have been implicated, including the following: drugs (oral contraceptives, minocycline, tetracycline, nitrofurantoin, phenytoin, sulfa drugs, tamoxifen, nalidixic acid, thyroid hormone replacement, methylphenidate, some chemotherapeutic drugs, and isotretinoic acid),4 obesity, systemic lupus erythematosus,5 and trisomy 21.6 Prompt recognition of IIH in the emergency department is important because timely intervention enables early institution of appropriate therapy to control headaches and may preserve vision.7 Headaches are the most common presenting symptom in both adults and children, but other symptoms include nausea, vomiting, transient visual disturbances, diplopia, and pulsatile intracranial noises.8 Although medical therapy with corticosteroids, acetazolamide, or furosemide is usually sufficient to normalize intracranial pressure, repeated lumbar puncture or a lumboperitoneal shunt may be required.9 The role of the ophthalmologist is important both in detecting subtle visual loss or disc abnormality and in monitoring follow-up treatment.10 The aims of this study were to examine the demographic patterns, predisposing factors, clinical features, disease course, and outcomes of younger versus older children presenting with IIH to the emergency department of our large tertiary care hospital during an 8-year period and to compare our findings with those of previous studies performed both in our institution and in other centers. We were also prompted to undertake the study by an impression that we were witnessing an increase in the number of patients with IIH in our pediatric department.

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. Disclosure: The authors declare no conflict of interest. Reprints: Miguel M. Glatstein, MD, Division of Pediatric Emergency Medicine, Department of Pediatrics, Dana-Dwek Children’s Hospital, Sackler School of Medicine, Tel Aviv University, 6 Weizman St, Tel-Aviv 64239, Israel (e‐mail: [email protected]). Miguel M. Glatstein, MD and Asaf Oren, MD contributed equally to this work as first authors. Copyright © 2015 by Lippincott Williams & Wilkins ISSN: 0749-5161

We retrospectively reviewed all charts of patients younger than 17 years who fulfilled the modified Dandy criteria for IIH11 and presented to the emergency department of the DanaDwek Children’s Hospital, Tel Aviv, Israel, between January 2000 and December 2008. Because we were interested in comparing prepubertal to pubertal patients with IIH and because Tanner staging is not routinely performed in the emergency department, we divided the patients by age. We defined prepubertal children as those younger than 11 years and pubertal patients as those with age between 11 and 17 years or older because, by the age of 11 years, most children have begun puberty.12

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 (

Clinical characterization of idiopathic intracranial hypertension in children presenting to the emergency department: the experience of a large tertiary care pediatric hospital.

Idiopathic intracranial hypertension (IIH) is a syndrome characterized by elevated intracranial pressure, without evidence of intracranial mass lesion...
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