Case 1: Acute-onset Vomiting, Fever, and Bulging Fontanelle in a 7-month-old Boy

Fernandez-Pol, Clarissa; Wallenstein, Matthew B.; Chua, Ian

doi:10.1542/pir.2016-0077

Cited by 2 publications

(4 citation statements)

References 10 publications

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“…Similarly to our patient, 3 other patients were on topical hydrocortisone prior to presentation with infantile idiopathic intracranial hypertension. [26][27][28] Idiopathic intracranial hypertension has previously been reported to be associated with topical steroid withdrawal. [29][30][31][32] Despite the exact mechanism remaining elusive, this is thought to occur more often in children and is hypothesized to be impacted by the duration of steroid administration and rate of withdrawal.…”

Section: Risk Factorsmentioning

confidence: 99%

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Infantile Idiopathic Intracranial Hypertension: A Case Study and Review of the Literature

et al. 2019

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Idiopathic intracranial hypertension, or pseudotumor cerebri, is an increase in cerebrospinal fluid pressure of unknown etiology. It is mostly seen in adults, less frequently in adolescents, rarely in younger children. Only 5 infants meeting idiopathic intracranial hypertension criteria have been mentioned in the literature. We report a case of a previously healthy 9-month-old boy who presented with irritability, decreased appetite, and a bulging fontanelle. Computed tomography (CT) head imaging and cerebrospinal fluid studies revealed normal results. The patient’s symptoms transiently resolved after the initial lumbar puncture, but 11 days later, his fontanelle bulged again. A second lumbar puncture revealed an elevated opening pressure of 35 cmH2O and led to a diagnosis of idiopathic intracranial hypertension in accordance with the modified Dandy Criteria. Treatment with acetazolamide at a dose of 25 mg/kg/d was initiated and the patient remained symptom-free for 6 weeks, followed by another relapse. His acetazolamide dose was increased to 37 mg/kg/d, with no further relapses to date. A diagnosis of idiopathic intracranial hypertension is challenging in infants, because the patients cannot yet verbalize typical idiopathic intracranial hypertension–related symptoms such as positional headaches, diplopia, or pulsatile tinnitus. Furthermore, it is more difficult to assess papilledema in that age group. If undetected and untreated, idiopathic intracranial hypertension may result in permanent visual deficits. Little is known about idiopathic intracranial hypertension in infants, and age-specific treatment guidelines are lacking. We discuss this rare case of infantile idiopathic intracranial hypertension and provide a review of the literature, including an overview of disease characteristics and outcomes of idiopathic intracranial hypertension in this very young age group.

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Section: Risk Factorsmentioning

confidence: 99%

“…In 2 patients, only single lumbar punctures were conducted, and no medication was administered. 26,39 In 2 other infants, who were on either oral or topical corticosteroids prior to presenting with idiopathic intracranial hypertension, treatment was the reintroduction and gradual reduction of steroids. 27,28…”

Section: Risk Factorsmentioning

confidence: 99%

Infantile Idiopathic Intracranial Hypertension: A Case Study and Review of the Literature

et al. 2019

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“…Open fontanels may decrease the development of papilledema in infantile IIH, and infants are uncooperative to eye examination, so evaluation of papilledema is difficult. 2 4 5 6 7 In our patient, ocular examination was performed suboptimally due to incompatibility, and no papilledema was detected. LP is one of the diagnostic criteria of IIH, and also, it may contribute to therapeutic options for the disease.…”

Section: Discussionmentioning

confidence: 74%

“…3 Two cases presented with infantile IIH improved with LP. 5 6 It was done for diagnostic purposes in our patient, but it did not contribute to the treatment.…”

Section: Discussionmentioning

confidence: 94%

Infantile Idiopathic Intracranial Hypertension: Case Report of an 8-Month-Old Child

Yasar,

Inan,

Akkaya

et al. 2024

Journal of Pediatric Neurology

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Idiopathic intracranial hypertension (IIH), a clinical disorder also known as pseudotumor cerebri, is characterized by increased intracranial pressure of unknown causes. Although it is most commonly observed in young obese women, IIH can also occur in the pediatric population; however, it is extremely rare in infants. Infants do not typically exhibit characteristic signs and symptoms of IIH, making it challenging to diagnose. Additionally, treatment modalities for this disease remain uncertain. We report an 8-month-old female child admitted to the pediatric emergency department with IIH. Our patient presented initially with fever, vomiting, and diarrhea, and then she developed inability to abduct the left eye. Papilledema was not detected in our patient. Magnetic resonance imaging and lumbar puncture contributed to diagnosis of the patient. Dexamethasone (0.5 mg/kg/d, twice a day) and acetazolamide (5 mg/kg/d) were administered; dexamethasone was stopped at the 48th hour after esotropia had resolved. The patient developed left ptosis in the first month after discharge. Acetazolamide was administered for a duration of 5 months and was discontinued once the patient's eye findings improved. With a sudden onset of neurological findings in a healthy infant with normal neuroimaging, IIH should be considered in the differential diagnosis and cerebrospinal fluid pressure should be measured. The principles of treatment for this disease are based on adult guidelines, but the efficacy of acetazolamide has also been reported in the pediatric population, like in our case.

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Case 1: Acute-onset Vomiting, Fever, and Bulging Fontanelle in a 7-month-old Boy

Cited by 2 publications

References 10 publications

Infantile Idiopathic Intracranial Hypertension: A Case Study and Review of the Literature

Infantile Idiopathic Intracranial Hypertension: A Case Study and Review of the Literature

Infantile Idiopathic Intracranial Hypertension: Case Report of an 8-Month-Old Child

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