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Clinical features and the role of magnetic resonance imaging in pediatric patients with intracranial hypertension

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Abstract

Increased intracranial hypertension (IIH) is a defined clinical condition; however, an unsolved pathophysiologic background usually creates problems in its diagnosis and proper approach. The aim of this study was to emphasize the clinical conditions and brain magnetic resonce imaging (MRI) clues of pediatric patients, especially this clinical entity with high morbidity. Here, we review the etiology, clinical presentation, brain MRI findings, and prognosis of IIH in children. The symptoms’ onset age ranged from 9 months to 16 years. Headache (81%), vomiting (37%), and diplopia (33.3%) were the most frequent symptoms. The most common etiologic factors were found to be obesity and dural venous sinus thrombosis. Cerebrospinal fluid (CSF) opening pressure had mean a mean value of 615.2 ± 248 mm H2O. A significant relationship was found between visual field impairment and height of CSF pressure (p < 0.001). Optic nerve sheath enlargement (88.8%) and optic nerve tortuosity (85.1%) were found as the most common brain MRI findings. Slit-like ventricle (37%), venous sinus thrombosis (29.6%), posterior globe sclera flattening (29.6%), empty sella (25.9%), and intraocular protrusion of the optic nerve (14.8%) were the other findings. A significant relationship was found between CSF opening pressure and the presence of optic nerve tortuosity (p = 0.002), and distension of the optic nerve sheath (p = 0.006). All patients received acetazolamide, only one patient underwent lumboperitoneal shunt, and only one received steroids. In children, IIH can present with different etiologies and symptoms. Brain MRI provides crucial clues in diagnosis. Urgent diagnosis and treatment planning are required to protect vision functions.

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References

  1. Sismanis A (1987) Otologic manifest ations of benign intracranial hypertension syndrome: diagnosis and management. Laryngoscope 97:1–17

    Article  CAS  Google Scholar 

  2. Friedman DI, Jacobson DM (2004) Idiopathic intracranial hypertension. J Neuro ophthalmol 24:138–145

    Article  Google Scholar 

  3. Rangwala LM, Liu GT (2007) Pediatric idiopathic intracranial hypertension. Surv Ophthalmol 52:597–617

    Article  Google Scholar 

  4. Wall M, George D (1991) Idiopathic intracranial hypertension. A prospective study of 50 patients. Brain 114:155–180

    Article  Google Scholar 

  5. Galgano MA, Deshaie EM (2013) An update on the management of pseudotumor cerebri. Clin Neurol Neurosurg 115:252–259

    Article  Google Scholar 

  6. Skau M, Brennum J, Gjerris F, Jensen R (2006) What is new about idiopathic intracranial hypertension? An updated review of mechanism and treatment. Cephalalgia 26:384–399

    Article  CAS  Google Scholar 

  7. Thambisetty M, Lavin PJ, Newman NJ, Biousse V (2007) Fulminant idiopathic intracranial hypertension. Neurology 68:229–232

    Article  Google Scholar 

  8. Sinclair AJ, Ball AK, Burdon MA, Clarke CE, Stewart PM, Curnow SJ, Rauz S (2008) Exploring the pathogenesis of IIH: an inflammatory perspective. J Neuroimmunol 201–2:212–220

    Article  Google Scholar 

  9. Ball AK, Clarke CE (2006) Idiopathic intracranial hypertension. Lancet Neurology 5:433–442

    Article  Google Scholar 

  10. Shofty B, Ben-Sira L, Constantini S, Freedman S, Kesler A (2012) Optic nerve sheath diameter on MR imaging: establishment of norms and comparison of pediatric patients with idiopathic intracranial hypertension with healthy controls. Am J Neuroradiol 33:366–369

    Article  CAS  Google Scholar 

  11. Bansal L, Niccoli L, Bailey A, Zuccoli G (2014) Imaging the eye in idiopathic intracranial hypertension. Headache 54:1046–1047

    Article  Google Scholar 

  12. Mandelstam S, Moon A (2004) MRI of optic disc edema in childhood idiopathic intracranial hypertension. Pediatr Radiol 34:362

    Article  Google Scholar 

  13. Hirfanoglu T, Aydin K, Serdaroglu A, Havali C (2015) Novel magnetic resonance imaging findings in children with intracranial hypertension. Pediatr Neurol 53:151–156

    Article  Google Scholar 

  14. Degnan AJ, Levy LM (2011) Pseudotumor cerebri: brief review of clinical syndrome and imaging findings. AJNR Am J Neuroradiol 32:1986–1993

    Article  CAS  Google Scholar 

  15. Passi N, Degnan AJ, Levy LM (2013) MR imaging of papilledema and visual pathways:effects of increased intracranial pressure and pathophysiologic mechanisms. AJNR Am J Neuroradiol 34:919–924

    Article  CAS  Google Scholar 

  16. Maralani PJ, Hassanlou M, Torres C, Chakraborty S, Kingstone M, Patel V, Zackon D, Bussière M (2012) Accuracy of brain imaging in the diagnosis of idiopathic intracranial hypertension. Clin Radiol 67:656–663

    Article  CAS  Google Scholar 

  17. Saindane AM, Bruce BB, Riggeal BD, Newman NJ, Biousse V (2013) Association of MRI findings and visual outcome in idiopathic intracranial hypertension. Am J Roentgenol 201:412–418

    Article  Google Scholar 

  18. Agid R, Farb RI, Willinsky RA, Mikulis DJ, Tomlinson G (2006) Idiopathic intracranial hypertension: the validity of cross-sectional neuroimaging signs. Neuroradiology 48:521–527

    Article  CAS  Google Scholar 

  19. Seitz J, Held P, Strotzer M, Müller M, Völk M, Lenhart M, Djavidani B, Feuerbach S (2002) Magnetic resonance imaging in patients diagnosed with papilledema: a comparison of 6 different high-resolution T1- and T2-weighted 3-dimensional and 2-dimensional sequences. J Neuroimaging 12:164–171

    Article  Google Scholar 

  20. Babikian P, Corbett J, Bell W (1994) Idiopathic intracranial hypertension in children: the Iowa experience. J Child Neurol 9:144–149

    Article  CAS  Google Scholar 

  21. Gordon K (1997) Pediatric pseudotumor cerebri: descriptive epidemiology. Can J Neurol Sci 24:219–221

    Article  CAS  Google Scholar 

  22. Rowe FJ (2011) Assessment of visual function in idiopathic intracranial hypertension. Br J Neurosurg 25:45–54

    Article  Google Scholar 

  23. Wall M, White WN (1998) Asymmetric papilledema in idiopathic intracranial hypertension: prospective intraocular comparison of sensory visual function. Invest Ophthalmol Vis Sci 39:134–142

    CAS  PubMed  Google Scholar 

  24. Bidot S, Saindane AM, Peragallo JH, Bruce BB, Newman NJ, Biousse V (2015) Brain imaging in idiopathic intracranial hypertension. J Neuro-Ophthalmol 35:400–411

    Article  Google Scholar 

  25. Rogers DL (2014) A review of pediatric idiopathic intracranial hypertension. Pediatr Clin North Am 61:579–590

    Article  Google Scholar 

  26. Hansen HC, Helmke K (1997) Validation of the optic nerve sheath response to changing cerebrospinal fluid pressure: ultrasound findings during intrathecal infusion tests. J Neurosurg 87:34–40

    Article  CAS  Google Scholar 

  27. Görkem SB, Doğanay S, Canpolat M, Koc G, Dogan MS, Per H, Coşkun A (2015) MR imaging findings in children with pseudotumor cerebri and comparison with healthy controls. Childs Nerv Syst 31:373–380

    Article  Google Scholar 

  28. Lim MJ, Pushparajah K, Jan W, Calver D, Lin J-P (2010) Magnetic resonance imaging changes in idiopathic intracranial hypertension in children. J Child Neurol 25:294–299

    Article  Google Scholar 

  29. Agarwal P, Kumar M, Arora V (2010) Clinical profile of cerebral venous sinus thrombosis and the role of imaging in its diagnosis in patients with presumed idiopathic intracranial hypertension. Indian J Ophthalmol 58:153–155

    Article  Google Scholar 

  30. Inokuchi G, Tsutsumi N, Komatsu H, Fujita T, Sawada N, Kumoi K (2013) Persistent petrosquamosal sinus: underlying cause of otitic hydrocephalus with lateral sinus thrombosis. Int J Pediatr Otorhinolaryngol 77:1908–1911

    Article  Google Scholar 

  31. Biousse V, Bruce BB, Newman NJ (2012) Update on the pathophysiology and management of idiopathic intracranial hypertension. J Neurol Neurosurg Psychiatry 83:488–494

    Article  Google Scholar 

  32. Dave SB, Subramanian PS (2014) Pseudotumor cerebri: an update on treatment options. Indian J Ophthalmol 62:996–998

    Article  Google Scholar 

  33. Celebisoy N, Gökçay F, Sirin H, Akyürekli O (2007) Treatment of idiopathic intracranial hypertension: topiramate vs acetazolamide, an open-label study. Acta Neurol Scand 116:322–327

    Article  CAS  Google Scholar 

  34. Matthews YY (2008) Drugs used in childhood idiopathic or benign intracranial hypertension. Arch Dis Child Educ Pract Ed 93:19–25

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Pediatric Neurology, Faculty of Medicine, Inönü University, Malatya, Turkey

    Betül Kılıç & Serdal Güngör

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  1. Betül Kılıç
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  2. Serdal Güngör
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Correspondence to Betül Kılıç.

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All authors declare that they have no conflicts of interest related to the present study.

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The study was conducted in accordance with the Helsinki Declaration and the study protocol was approved by the corporate ethics committee.

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Informed consent had been obtained from all all subjects included in the study.

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Kılıç, B., Güngör, S. Clinical features and the role of magnetic resonance imaging in pediatric patients with intracranial hypertension. Acta Neurol Belg 121, 1567–1573 (2021). https://doi.org/10.1007/s13760-020-01415-1

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  • DOI: https://doi.org/10.1007/s13760-020-01415-1

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