Predictors of Primary Intracranial Hypertension in Children Using a Newly Suggested Opening Pressure Cutoff of 280 mm H2O

Delaney, Atima C; Velarde, Aynslee; Harper, Marvin B.; Lebel, Alyssa; Landschaft, Assaf; Monuteaux, Michael C.; Heidary, Gena; Kimia, Amir A.

doi:10.1016/j.pediatrneurol.2018.09.013

Cited by 4 publications

(2 citation statements)

References 31 publications

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“…Studies showed that children are at a higher risk of neurologic complications using higher opening pressure cutoff values (250 and 280 mm H₂O). 32,33 Therefore, it should be noted that the borderline opening pressures or lower opening pressure values than expected for a definite diagnosis should not exclude idiopathic intracranial hypertension in pediatric patients. The diagnosis of idiopathic intracranial hypertension should still be probable in children with opening pressure higher than 200 mm H₂O and the treatment decision should not depend solely on the opening pressure values.…”

Section: Discussionmentioning

confidence: 99%

Neuroimaging Features of Intracranial Hypertension in Pediatric Patients With New-Onset Idiopathic Seizures, a Comparison With Patients with Confirmed Diagnosis of Idiopathic Intracranial Hypertension: A Preliminary Study

et al. 2021

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Seizures have been reported in association with idiopathic intracranial hypertension in pediatric patients. Magnetic resonance imaging (MRI) signs of intracranial hypertension have not been investigated before in pediatric patients with new-onset idiopathic seizures. MRI scans of 182 pediatric patients were retrospectively analyzed for imaging findings of intracranial hypertension, including 46 patients with new-onset idiopathic seizures and elevated cerebrospinal fluid opening pressure, 40 patients with new-onset idiopathic seizures and normal opening pressure, 56 patients with confirmed idiopathic intracranial hypertension, and 40 age- and sex-matched controls. The optic nerve sheath diameter is significantly larger in the group with new-onset idiopathic seizures and elevated opening pressure (mean diameter of 6.02 ± 0.45 mm) compared to patients with new-onset idiopathic seizures and normal opening pressure (mean diameter of 5.24 ± 0.50 mm) ( P value <.001). The cutoff value of 6.0 mm for optic nerve sheath diameter showed 63% sensitivity and 88% specificity to differentiate pediatric patients with seizures and elevated opening pressure from those with seizures and normal opening pressure. Conclusion A cutoff value of 6.0 mm for optic nerve sheath dilation may be used as a screening imaging marker to suspect elevated opening pressure with specificity of 88% in pediatric patients with new-onset idiopathic seizures.

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Section: Discussionmentioning

confidence: 99%

Neuroimaging Features of Intracranial Hypertension in Pediatric Patients With New-Onset Idiopathic Seizures, a Comparison With Patients with Confirmed Diagnosis of Idiopathic Intracranial Hypertension: A Preliminary Study

et al. 2021

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“…16 In another study of only children with IIH, 67% (8/12) had > 280 mm CSF (nearly all lumbar punctures with sedation). 17 A larger retrospective cross-sectional study of 374 children 18 who underwent a lumbar puncture in the emergency room for a workup of IIH (not specified if diagnosed with IIH) had opening pressures in 52% (n ¼ 194) 200 mm CSF, 34% (n ¼ 127) 250 mm CSF, and 28% (n ¼ 105) 280 mm CSF. Although there is much debate over opening pressure thresholds of 200 versus 250 versus 280 mm CSF, it is important to remember that this is a single number at a single point in time, and the diagnoses or treatment should not be withheld or given according to this number.…”

Section: The Pediatric Pseudotumor Cerebri Syndrome Criteriamentioning

confidence: 99%

Update in Pediatric Pseudotumor Cerebri Syndrome

Beres

2020

Semin Neurol

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Pseudotumor cerebri syndrome (PTCS) is a rare condition in children presenting with headache and papilledema from increased intracranial pressure that can cause significant morbidity. This can be idiopathic, also known as idiopathic intracranial hypertension or primary intracranial hypertension, or can be secondary to medications and associated medical conditions. Given the threat to vision, early detection and treatment is needed in all age groups. However, identifying papilledema or pseudopapilledema in children presents unique challenges sometimes as a result of differences between prepubertal and postpubertal children, further elucidating the complex pathophysiology. Management requires brain imaging, lumbar puncture, and frequent eye exams with medical and rarely surgical treatment. Visual outcomes in children are favorable if caught early and management can be prolonged over years. Pediatric PTCS is different from adult PTCS in many ways, and this review will focus on the most updated definitions of the disease, theories of pathophysiology, management, and treatment in the pediatric population.

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