Idiopathic Intracranial Hypertension in Children: A Review and Algorithm

An 8-Year-Old Girl with Headache and Syncope

“…4 In addition, cranial nerve palsies, most commonly sixth nerve palsy, leading to double vision may also occur. 7 Unlike this patient, syncope or loss of consciousness is not a typical manifestation of IIH.…”

“…The headache may be worsened with Valsalva maneuvers and changes in posture. 7 Children also may describe the headache as associated with photophobia, nausea, and vomiting. 4,6 Occasionally, IIH may present without headache, and these children are more likely to present with vision loss and have a poorer prognosis.…”

“…Opening pressure should be measured and fl uid sent for CSF studies. 7 There is debate over what constitutes an elevated opening pressure. Adult studies typically consider an opening pressure of at least 250 mm H 2 0 to be consistent with IIH.…”

“…Furosemide is an alternative to acetazolamide or can be used as adjunct therapy. 7,9 Topiramate is promising as headache treatment if neither acetazolamide or furosemide are tolerable case challenges and effective. Topiramate has some carbonic anhydrase activity and has a typical side effect of weight loss, which is benefi cial in obese patients.…”

Connecting raised intracranial pressure and cognitive delay in craniosynostosis: many assumptions, little evidence

“…Although ICP can reach levels that, if not relieved, can cause papilledema leading to optic atrophy and severe visual loss, impaired cognitive function has not been described. 2,44,66,69,87 That is not to say that IIH arising in childhood does not affect NCI-it may not have been looked for, as it has been in a study (in adults) by Yri et al, 88 who found that "patients with IIH performed significantly worse than controls in four of six cognitive domains. .…”