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Non-traumatic pediatric intracranial hypertension: key points for different etiologies, diagnosis, and treatment

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Abstract

Intracranial hypertension can be an acute life-threatening event or slowly deteriorating condition, leading to a gradual loss of neurological function. The diagnosis should be taken in a timely fashioned process, which mandates expedite measures to save brain function and sometimes life. An optimal management strategy is selected according to the causative etiology with a core treatment paradigm that can be utilized in various etiologies. Distinct etiologies are intracranial bleeds caused by traumatic brain injury, spontaneous intracranial hemorrhage (e.g., neonatal intraventricular hemorrhage), or the rare pediatric hemorrhagic stroke. The other primary pediatric etiologies for elevated intracranial pressure are intracranial mass (e.g., brain tumor) and hydrocephalus related. Other unique etiologies in the pediatric population are related to congenital diseases, infectious diseases, metabolic or endocrine crisis, and idiopathic intracranial pressure. One of the main goals of treatment is to alleviate the growing pressure and prevent the secondary injury to brain parenchyma due to inadequate blood perfusion and eventually inadequate parenchymal oxygenation and metabolic state. Previous literature discussed essential characteristics of the treatment paradigm derived mainly from pediatric brain traumatic injuries’ treatment methodology. Yet, many of these etiologies are not related to trauma; thus, the general treatment methodology must be tailored carefully for each patient. This review focuses on the different possible non-traumatic etiologies that can lead to intracranial hypertension with the relevant modification of each etiology’s treatment paradigm based on the current literature.

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Authors and Affiliations

  1. Department of Neurosurgery, Johns Hopkins Medicine, Institute for Brain Protection Sciences, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA

    Nir Shimony & George I. Jallo

  2. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Nir Shimony & George I. Jallo

  3. Geisinger Medical Center, Neuroscience Institute, Danville, PA, USA

    Nir Shimony

  4. Geisinger Commonwealth School of Medicine, Scranton, PA, USA

    Nir Shimony

  5. University of South Florida, Tampa, FL, USA

    Meleine Martinez-Sosa, Brooks Osburn & George I. Jallo

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NS—Text drafting, text revision, conception and design of the work, literature review, supervising, image editing. MM-S—Text drafting and editing, literature review. BO—Text drafting and editing, literature review. GIJ—Text revision, conception and design of the work, supervising and final approval for publication, image editing.

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Shimony, N., Martinez-Sosa, M., Osburn, B. et al. Non-traumatic pediatric intracranial hypertension: key points for different etiologies, diagnosis, and treatment. Acta Neurol Belg 121, 823–836 (2021). https://doi.org/10.1007/s13760-021-01626-0

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