Secondary intracranial hypertension (pseudotumor cerebri) presenting as post-traumatic headache in mild traumatic brain injury: a case series
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Cerebral edema peaks 36–72 h after moderate traumatic brain injury but thought to be uncommon after mild traumatic brain injury. Post-traumatic headache can develop 48–72 h post-injury, perhaps reflecting the developing cerebral edema. Pseudotumor cerebri can result from various causes, including cerebral edema, and is characterized by increased intracranial pressure, headache, visual, and other common symptoms. Our objective was to report a phenotypically identifiable post-traumatic headache subtype.
Case series presentation
This case series of six pediatric patients with post-traumatic pseudotumor cerebri was assessed at 48–120 h post-primary injury with new or a change in symptoms such as headache, vision, auditory, balance, and cognition. Clinical findings included slight fever, neck/head pain, papilledema or cranial nerve deficit (6th), and lack of coordination. Elevated cerebral spinal fluid pressure was documented by lumbar puncture, with no infection. Symptoms improved with treatment specific to post-traumatic headache subtype (lumbar puncture, topiramate, or acetazolamide).
Recognition of specific post-traumatic headache subtypes after mild traumatic brain injury will expedite treatment intervention to lower intracranial pressure and resolve symptoms.
KeywordsIdiopathic intracranial hypertension Post-traumatic headache Acetazolamide Intracranial pressure Pseudotumor cerebri Concussion
body mass index
cerebral blood flow
central nervous system
cerebral spinal fluid
idiopathic intracranial hypertension
magnetic resonance imaging
magnetic resonance venography
mild traumatic brain injury
post-traumatic pseudotumor cerebri
Tonia Sabo contributed the data for the case presentations, conducted the literature review, and wrote the manuscript. Sushmita Purkayastha contributed to the literature review and the writing of the manuscript. Charlene Supnet contributed to the writing of the manuscript.
This study was not funded by any public, commercial, or not-for-profit entity.
Compliance with ethical standards
Ethics approval and consent to participate
Research described in this case series involving human subjects and data was performed in accordance with the Declaration of Helsinki. This study was reviewed and approved by the University of Texas Southwestern Medical Center Institutional Review Board (STU 092016-046). Consent for the publication of each of the cases and any additional related information, including case details and images, was taken from all the patients/parents of the minors involved in the study.
Conflict of interest
Authors have no financial or non-financial competing interests to report.
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