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

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.

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Availability of data and materials

Data supporting the conclusions of this article are included within the article.

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

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Funding

This study was not funded by any public, commercial, or not-for-profit entity.

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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.

Corresponding authors

Correspondence to Tonia Sabo or Charlene Supnet or Sushmita Purkayastha.

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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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Sabo, T., Supnet, C. & Purkayastha, S. Secondary intracranial hypertension (pseudotumor cerebri) presenting as post-traumatic headache in mild traumatic brain injury: a case series. Childs Nerv Syst 34, 681–690 (2018). https://doi.org/10.1007/s00381-017-3681-x

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Keywords

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