Original Paper

Child's Nervous System

, Volume 27, Issue 11, pp 1913-1918

Idiopathic intracranial hypertension in children: visual outcome and risk of recurrence

  • Uri SoibermanAffiliated withNeuro-Opthalmology Unit, Department of Ophthalmology, Tel Aviv Medical CenterDepartment of Ophthalmology, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University Email author 
  • , Chaim StolovitchAffiliated withDepartment of Ophthalmology, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University
  • , Laura J. BalcerAffiliated withDepartment of Neurology, University of Pennsylvania School of Medicine
  • , Michael RegenbogenAffiliated withDepartment of Ophthalmology, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University
  • , Shlomi ConstantiniAffiliated withDepartment of Pediatric Neurosurgery, Dana Children’s Hospital, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University
  • , Anat KeslerAffiliated withNeuro-Opthalmology Unit, Department of Ophthalmology, Tel Aviv Medical CenterDepartment of Ophthalmology, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University

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Abstract

Purpose

Idiopathic intracranial hypertension (IIH) is a disorder associated with increased intracranial pressure without evidence of a space-occupying lesion and with normal cerebrospinal fluid constituents. The disease is rare in the pediatric population. In this study, we assessed the visual outcome of children with IIH and the risk of recurrence.

Methods

This single-center observational retrospective cohort study included 90 children younger than 18 years of age who satisfied the modified Dandy criteria for the diagnosis of IIH. Upon follow-up, the treatment was discontinued when patients were free of symptoms such as headaches, transient visual obscurations or tinnitus, and when examination revealed no evidence of papilledema. The main outcome measures were visual acuity and visual field outcomes as well as risk of recurrence.

Results

The mean follow-up was 30.65 months (range 1.15–172.6 months, standard deviation 27.47 months). Special grading scales were devised for visual acuity and visual field scores. The mean visual acuity score improved from 4.7 ± 0.62 to 4.87 ± 0.44 (p = 0.003).The mean visual field score improved from 3.41 ± 0.8 to 3.52 ± 0.75 (p = 0.21). The recurrence rate was 23.7%, and the risk of recurrence was highest within the first 18 months after diagnosis of IIH.

Conclusions

These study results suggest that pediatric patients with IIH have a favorable visual outcome in terms of both visual acuity and visual field. If there is any recurrence, it is most likely to occur during the first 18 months after diagnosis.

Keywords

Idiopathic intracranial hypertension Pseudotumor cerebri Pediatrics Recurrence Visual outcome