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Child's Nervous System

, Volume 34, Issue 4, pp 681–690 | Cite as

Secondary intracranial hypertension (pseudotumor cerebri) presenting as post-traumatic headache in mild traumatic brain injury: a case series

  • Tonia SaboEmail author
  • Charlene SupnetEmail author
  • Sushmita PurkayasthaEmail author
Original Paper

Abstract

Background

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).

Conclusions

Recognition of specific post-traumatic headache subtypes after mild traumatic brain injury will expedite treatment intervention to lower intracranial pressure and resolve symptoms.

Keywords

Idiopathic intracranial hypertension Post-traumatic headache Acetazolamide Intracranial pressure Pseudotumor cerebri Concussion 

Abbreviations

BMI

body mass index

CBF

cerebral blood flow

CE

cerebral edema

CNS

central nervous system

CSF

cerebral spinal fluid

CT

computed tomography

ICP

intracranial pressure

IIH

idiopathic intracranial hypertension

MRI

magnetic resonance imaging

MRV

magnetic resonance venography

mTBI

mild traumatic brain injury

PCS

post-concussion symptom

PTC

pseudotumor cerebri

PTPTC

post-traumatic pseudotumor cerebri

PTH

post-traumatic headache

Notes

Authors’ contributions

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.

Funding

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.

References

  1. 1.
    Aylward SC, Waslo CS, Au JN, Tanne E (2016) Manifestations of pediatric intracranial hypertension from the intracranial hypertension registry. Pediatr Neurol 61:76–82.  https://doi.org/10.1016/j.pediatrneurol.2016.04.007 CrossRefPubMedGoogle Scholar
  2. 2.
    Claassen J, Carhuapoma JR, Kreiter KT, Du EY, Connolly ES, Mayer SA (2002) Global cerebral edema after subarachnoid hemorrhage: frequency, predictors, and impact on outcome. Stroke 33(5):1225–1232.  https://doi.org/10.1161/01.STR.0000015624.29071.1F CrossRefPubMedGoogle Scholar
  3. 3.
    Defrin R (2014) Chronic post-traumatic headache: clinical findings and possible mechanisms. J Man Manip Ther 22(1):36–44.  https://doi.org/10.1179/2042618613Y.0000000053 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Faul MXL, Wald MM, Coronado VG (2010) Traumatic brain injury in the United States: emergency department visits, hospitalizations and deaths 2002–2006. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, AtlantaCrossRefGoogle Scholar
  5. 5.
    Galetta SL, Balcer LJ (2013) All choked up about the pseudotumor cerebri syndrome. Neurology 81(13):1112–1113.  https://doi.org/10.1212/WNL.0b013e3182a55ff7 CrossRefPubMedGoogle Scholar
  6. 6.
    Greenberg JK, Stoev IT, Park TS, Smyth MD, Leonard JR, Leonard JC, Pineda JA, Limbrick DD (2014) Management of children with mild traumatic brain injury and intracranial hemorrhage. J Trauma Acute Care Surg 76(4):1089–1095.  https://doi.org/10.1097/TA.0000000000000155 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Headache Classification Committee of the International Headache Society (IHS) (2013) The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 33:629–808CrossRefGoogle Scholar
  8. 8.
    Ivkovic M, Reiss-Zimmermann M, Katzen H, Preuss M, Kovanlikaya I, Heier L, Alperin N, Hoffmann KT, Relkin N (2015) MRI assessment of the effects of acetazolamide and external lumbar drainage in idiopathic normal pressure hydrocephalus. Fluid Barrier CNS 12(1):9–12.  https://doi.org/10.1186/s12987-015-0004-z CrossRefGoogle Scholar
  9. 9.
    Karadas O, Gul HL, Ozturk B, Eroglu E, Demirkaya S (2014) The effects of topiramate therapy on cerebral metabolism in migraine with aura patients. Turk Neurosurg 24(5):704–709.  https://doi.org/10.5137/1019-5149.JTN.9059-13.1 PubMedGoogle Scholar
  10. 10.
    Kruschitz R, Wallner-Liebmann SJ, Hamlin MJ, Moser M, Ludvik B, Schnedl WJ, Tafeit E (2013) Detecting body fat-a weighty problem BMI versus subcutaneous fat patterns in athletes and non-athletes. PLoS One 8(8):e72002.  https://doi.org/10.1371/journal.pone.0072002 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Krymchantowski AV, Jevoux CC (2011) Topiramate vs divalproex sodium in the preventive treatment of migraine: a prospective “real-world” study. Headache 51(4):554–558.  https://doi.org/10.1111/j.1526-4610.2011.01868.x CrossRefPubMedGoogle Scholar
  12. 12.
    Lew HL, Lin PH, Fuh JL, Wang SJ, Clark DJ, Walker WC (2006) Characteristics and treatment of headache after traumatic brain injury: a focused review. Am J Phys Med Rehabil/Assoc Acad Phys 85(7):619–627.  https://doi.org/10.1097/01.phm.0000223235.09931.c0 CrossRefGoogle Scholar
  13. 13.
    Lucas S, Hoffman JM, Bell KR, Walker W, Dikmen S (2012) Characterization of headache after traumatic brain injury. Cephalalgia 32(8):600–606.  https://doi.org/10.1177/0333102412445224 CrossRefPubMedGoogle Scholar
  14. 14.
    Markey KA, Mollan SP, Jensen RH, Sinclair AJ (2016) Understanding idiopathic intracranial hypertension: mechanisms, management, and future directions. Lancet Neurol 15(1):78–91.  https://doi.org/10.1016/S1474-4422(15)00298-7 CrossRefPubMedGoogle Scholar
  15. 15.
    Piovesan EJ, Lange MC, Piovesan Ldo R, de Almeida SM, Kowacs PA, Werneck LC (2002) Long-term evolution of papilledema in idiopathic intracranial hypertension: observations concerning two cases. Arq Neuropsiquiatr 60(2B):453–457.  https://doi.org/10.1590/S0004-282X2002000300021 CrossRefPubMedGoogle Scholar
  16. 16.
    Saadoun S, Papadopoulos MC (2010) Aquaporin-4 in brain and spinal cord oedema. Neuroscience 168(4):1036–1046.  https://doi.org/10.1016/j.neuroscience.2009.08.019 CrossRefPubMedGoogle Scholar
  17. 17.
    Shah LM, McLean LA, Heilbrun ME, Salzman KL (2013) Intracranial hypotension: improved MRI detection with diagnostic intracranial angles. AJR Am J Roentgenol 200(2):400–407.  https://doi.org/10.2214/AJR.12.8611 CrossRefPubMedGoogle Scholar
  18. 18.
    Silberstein SD, Lipton RB, Dodlick DJ (eds) (2001) Wolff’s headache and other head pain. Oxford University Press, New YorkGoogle Scholar
  19. 19.
    Stiebel-Kalish H, Eyal S, Steiner I (2013) The role of aquaporin-1 in idiopathic and drug-induced intracranial hypertension. Med Hypotheses 81(6):1059–1062.  https://doi.org/10.1016/j.mehy.2013.10.002 CrossRefPubMedGoogle Scholar
  20. 20.
    Theeler BJ, Flynn FG, Erickson JC (2010) Headaches after concussion in US soldiers returning from Iraq or Afghanistan. Headache 50(8):1262–1272.  https://doi.org/10.1111/j.1526-4610.2010.01700.x CrossRefPubMedGoogle Scholar
  21. 21.
    Wall M, McDermott MP, Kieburtz KD, Corbett JJ, Feldon SE, Friedman DI, Katz DM, Keltner JL, Schron EB, Kupersmith MJ, Committee NIIHSGW (2014) Effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: the idiopathic intracranial hypertension treatment trial. JAMA 311(16):1641–1651.  https://doi.org/10.1001/jama.2014.3312 CrossRefPubMedGoogle Scholar
  22. 22.
    Watanabe TK, Bell KR, Walker WC, Schomer K (2012) Systematic review of interventions for post-traumatic headache. PM R: J Inj Funct Rehabil 4(2):129–140.  https://doi.org/10.1016/j.pmrj.2011.06.003 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of PediatricsUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Children’s Health Children’s Medical CenterDallasUSA
  3. 3.Department of Neurology and NeurotherapeuticsUniversity of Texas Southwestern Medical CenterDallasUSA
  4. 4.Department of Applied Physiology and WellnessSouthern Methodist UniversityDallasUSA

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