Mismatch between production and resorption of CSF leading to increased intracranial fluid, or due to abnormalities in cerebral blood flow
Causes
Idiopathic
Obesity
Excess vitamin A
Tetracyclines
Infections
Diagnosis
Usually normal MRI
Confirmed with lumbar puncture
Elevated opening pressure
Normal CSF analysis
3 diagnostic criteria
Increased intracranial pressure as evidenced by elevated opening pressure on LP and/or symptoms
Normal brain anatomy
Normal CSF analysis
Neurological exam and fundoscopy may reveal peripheral loss of vision which is one of the complications IIH if left untreated
Treatment
First line – acetazolamide – decreases production of CSF
Second line – add furosemide
Surgery
CSF shunt
Lumboperitoneal shunt – directs CSF from the subarachnoid space of the lumbar space to the peritoneum
Ventriculoperitoneal shunt – directs CSF from one of the ventricles in the brain to the peritoneum
Cisterna magnum – last resort shunt, directs CSF from the cervical cistern to the peritoneum
Cerebrospinal stenting
If imaging have revealed major narrowing of a major vein or sinus, which is causing the intracranial pressure to also rise, a stent can be placed to open the vein or sinus back up
Directed history of headaches in pediatrics
Sudden onset – can be a sign of SAH or intracranial hemorrhage
Most severe headache, or unlike previous headaches
Headaches that occur after a long period of lying down (morning, or nap) – increased intracranial pressure
Awakens from sleep – increased intracranial pressure
Worsens with cough or Valsalva – increased intracranial pressure
Cushing’s triad of increased intracranial pressure
Bradycardia
Irregular respirations
High blood pressure
Fever and photophobia – while photophobia is seen in pediatrics, both fever and photophobia are also seen in meningitis or encephalitis which can be life threatening
Progressively worsening – increasing in frequency and severity over time
Longstanding headache that is acutely worse – points to underlying pathology, needs investigation
Associated neurological symptoms
History of allergies – points toward sinusitis
Poor visual acuity, difficulty reading or seeing the board – poor eyesight can lead to recurrent headaches