Case Series of Rapid Surgical Interventions in Fulminant Intracranial Hypertension

Abstract

Aims: Examine ophthalmologic outcomes and complications of lumbar drain and cerebrospinal fluid shunts in pediatric fulminant intracranial hypertension. Methods: Patients under 21 years of age with a diagnosis of fulminant intracranial hypertension with temporary lumbar drain only, shunt after lumbar drain, and shunt only were included. Parameters investigated include lumbar drain data, medication freedom, time to resolution of papilledema, improvement in cranial nerve palsy, afferent pupillary defects, visual fields, visual acuity, and complications of each intervention. Results: Four patients had temporary lumbar drain, 2 temporary lumbar drain and cerebrospinal fluid shunt, and 3 shunt only. All achieved medication freedom and resolution of papilledema and cranial nerve palsies (if present). Most had resolution of preprocedure afferent pupillary defects. Minor residual visual field deficits occurred in 67%, and all had visual acuity improvement. One patient’s lumbar drain dislodged, and one patient had 2 cerebrospinal fluid shunt revisions. Conclusion: Temporary lumbar drain with medical therapy may be a viable first approach to fulminant intracranial hypertension.

Secondary Intracranial Hypertension in Pediatric Lyme Meningitis

“…Previous studies have shown that lumbar drains have clinical benefits for fulminant intracranial hypertension patients. Ploof et al 9 found that lumbar drains were a viable first option for fulminant intracranial hypertension in the case of IIH and when secondary to influenza and viral meningitis. They noted that treatments were relatively similar and all patients improved on the lumbar drain in spite of having concerns for vision loss on maximum medical therapy.…”

“…It is defined as the acute onset or rapid progression of increased intracranial pressure with evidence of severe vision loss. 9…”

“…It is defined as the acute onset or rapid progression of increased intracranial pressure with evidence of severe vision loss. 9 We performed a review of Lyme meningitis cases seen in the Nationwide Children's Hospital institution's pediatric intracranial hypertension clinic over a 12-year period to look at initial presentation, neurologic symptoms, presence of papilledema, and management and treatment of intracranial hypertension secondary to Lyme disease.…”

Pediatric intracranial hypertension: A review of presenting symptoms, quality of life, and secondary causes

“…Ploof et al reported nine patients who were aggressively treated for FIH. 63 At presentation, all patients had headache, vision changes, and papilledema with two being considered legally blind. The average time from IH diagnosis to FIH diagnosis was 14.6 days.…”