Pediatric idiopathic intracranial hypertension.

1. Genevieve Mercille, MD*
2. Luis H. Ospina, MD†


 

1. *Resident in Ophthalmology, Pediatric and Neuro-Ophthalmology Sections, Ste-Justine Hospital, Montreal, Quebec, Canada

2. †Associate Professor in Ophthalmology, University of Montreal, Montreal, Quebec, Canada

After completing this article, readers should be able to: 

1. List the diagnostic criteria for idiopathic intracranial hypertension (IIH).

2. Discuss the epidemiology, risk factors, and clinical manifestations of IIH in a pediatric population.

3. Describe the differential diagnoses and conditions associated with IIH.

4. Suggest appropriate therapeutic options for IIH.

5. Identify the principal complication of IIH and how it may be prevented.

Idiopathic intracranial hypertension (IIH), previously referred to as pseudotumor cerebri or benign intracranial hypertension, was recognized initially in adults by Quincke in 1893 as “meningitis serosa.” (1) The syndrome is characterized by elevated intracranial pressure (ICP) without any evident underlying neurologic disease. The modified Dandy criteria, which were developed based on an adult population, can assist in establishing the diagnosis of IIH (Table 1) (2).

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* Adapted from Friedman and Jacobson (3).

 Table 1. 
Diagnostic Criteria for Idiopathic Intracranial Hypertension





Interestingly, children who have IIH may display a greater spectrum of clinical presentations than adults, and the disorder may have special epidemiologic characteristics in children.

IIH occurs most commonly in young adults and rarely is seen in those older than age 45 years. The overall annual incidence is 0.9 per 100,000 individuals, (4) and there is a strong female predilection among affected adults. The incidence of IIH increases to 3.5 per 100,000 in women ages 20 to …

Pediatric idiopathic intracranial hypertension: a review.

Background.—Diseases that present with protean manifestations are the diseases most likely to pose diagnostic challenges for both clinicians and pathologists. Among the most diverse disorders caused by a single known toxic, metabolic, neoplastic, or infectious agent are the central and peripheral nervous system complications of varicella-zoster virus (VZV). Methods.—The pathologic correlates of the neurologic complications of VZV infection, as well as current methods for detecting viral infections, are discussed and presented in pictorial format for the practicing pathologist. Results.—Varicella-zoster virus causes chickenpox (varicella), usually in childhood; most children manifest only mild neurologic sequelae. After chickenpox resolves, the virus becomes latent in neurons of cranial and spinal ganglia of nearly all individuals. In elderly and immunocompromised individuals, the virus may reactivate to produce shingles (zoster). After zoster resolves, many elderly patients experience postherpeti...

Varicella-Zoster Virus Infections of the Nervous System

Objective: This review focuses on classification and description of and current treatment recommendations for psychocutaneous disorders. Medication side effects of both psychotropic and dermatologic drugs are also considered.

Data Sources: A search of the literature from 1951 to 2004 was performed using the MEDLINE search engine. English-language articles were identified using the following search terms: skin and psyche, psychiatry and dermatology, mind and skin, psychocutaneous, and stress and skin.

Data Synthesis: The psychotropic agents most frequently used in patients with psychocutaneous disorders are those that target anxiety, depression, and psychosis. Psychiatric side effects of dermatologic drugs can be significant but can occur less frequently than the cutaneous side effects of psychiatric medications. In a majority of patients presenting to dermatologists, effective management of skin conditions requires consideration of associated psychosocial factors. For some dermatologic conditions, there are specific demographic and personality features that commonly associate with disease onset or exacerbation.

Conclusions: More than just a cosmetic disfigurement, dermatologic disorders are associated with a variety of psychopathologic problems that can affect the patient, his or her family, and society together. Increased understanding of biopsychosocial approaches and liaison among primary care physicians, psychiatrists, and dermatologists could be very useful and highly beneficial.

/pdf/psychodermatology-a-guide-to-understanding-common-2oi2q7bnkq.pdf

Psychodermatology: A Guide to Understanding Common Psychocutaneous Disorders

https://www.neurologic.theclinics.com/article/S0733-8619(14)00002-4/pdf

The Pseudotumor Cerebri Syndrome

This study describes a non-pharmacological treatment modality for children with trichotillomania. Three children with trichotillomania were treated using a hypnotherapy technique. All patients were observed in the outpatient clinic for 8 consecutive weeks and subsequently followed for 12-18 months. All children were cooperative in performing the hypnotherapy technique (relaxation/mental imagery). Two patients reported complete resolution of their complaints after 7-8 weeks and 1 patient after 16 weeks. The latter, reporting recurrence of the complaint after 4 weeks due to stressful school problems, was resolved after successful retreatment over 3 weeks. During a mean follow-up period of 16 months, there were no recurrences. In conclusion, hypnotherapy may be considered as a primary treatment modality for trichotillomania in children without associated emotional disorders.

Hypnotherapy: an effective treatment modality for trichotillomania.

Pseudotumour cerebri is a clinical syndrome characterized by increased intracranial pressure in the absence of intracranial pathology. The possible association between this condition and infections has already been mentioned in a few case series. This paper describes a 6-y-old girl with a classical picture of pseudotumour cerebri which developed 1 week following varicella. To the authors' knowledge, this is the first description suggesting this association. Additional reports are required to support the possible relationship between the two conditions.

Pseudotumour cerebri complicating varicella in a child

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Hypnotherapy: an effective treatment modality for trichotillomania.

Pseudotumour cerebri complicating varicella in a child