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Update on the evaluation of pediatric idiopathic intracranial hypertension

Gilbert, Aubrey L.; Heidary, Gena

Current Opinion in Ophthalmology: November 2016 - Volume 27 - Issue 6 - p 493–497
doi: 10.1097/ICU.0000000000000317
NEURO-OPHTHALMOLOGY: Edited by Dean M. Cestari
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Purpose of review Papilledema associated with idiopathic intracranial hypertension (IIH) may result in irreversible, progressive visual loss. The development of tools for the evaluation of pediatric patients with IIH is particularly relevant as many patients may not be able to comply with the detailed clinical evaluation utilized in adults for the treatment and management of this disease. The purpose of this review is to summarize relevant articles on the diagnostic tools used in evaluation and management of pediatric IIH.

Recent findings Studies suggest that characteristic pediatric IIH MRI findings include empty sella turcica, decreased pituitary gland size, optic nerve tortuosity, perioptic subarachnoid space enlargement, posterior globe flattering, and intraocular protrusion of the optic nerve head. On optical coherence tomography (OCT), increased retinal nerve fiber layer and macular thickness may be observed in children with IIH compared with controls. The retinal nerve fiber layer thickness seems to coincide with the severity of papilledema and may be more sensitive than funduscopy for detecting optic nerve head elevation. Research on ultrasound of the optic nerve shows increased size of the optic nerve sheath diameter in pediatric IIH patients, and this may correlate with increased opening pressure on lumbar puncture.

Summary There appears to be characteristic findings on MRI, OCT, and ultrasound studies in pediatric IIH patients. Although ultrasound is rarely used for monitoring these patients nowadays, MRI and OCT can be useful in the evaluation and management of these individuals.

Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, and Massachusetts Eye & Ear Infirmary, Boston, Massachusetts, USA

Correspondence to Aubrey L. Gilbert, MD, PhD, Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, and Massachusetts Eye & Ear Infirmary, 243 Charles Street, Boston, MA 02114, USA. Tel: +1 617 523 7900; e-mail: aubrey_gilbert@meei.harvard.edu

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