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Intracranial hypertension

a current review

Jordan, Catherine O.a; Aylward, Shawn C.b

doi: 10.1097/MOP.0000000000000689
NEUROLOGY: Edited by Robert C. Tasker

Purpose of review To provide a current review of recent publications with regards to intracranial hypertension.

Recent findings Attempts were made to provide pediatric data; however, the recent completion of the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) has provided a wealth of data with regards to adult intracranial hypertension.

The pediatric incidence of intracranial hypertension ranges between 0.63 and 0.71 per 100 000 children. A majority of pediatric cases responded to acetazolamide, with resolution of headache averaging 3.8 weeks. Most patients require less than 1 year of treatment with male sex, older age at diagnosis, primary intracranial hypertension, and lack of headache being predictors of good response. Fluorescein angiography has the highest accuracy in distinguishing true papilledema from pseudopapilledema. The IIHTT found Frisen grade of papilledema was within 1 grade in 92.8% of patients. Monitoring of potassium levels is not required and aplastic anemia was not seen in patients taking acetazolamide.

Summary Although the newer pediatric studies report incidence rates in pediatric intracranial hypertension are lower than seen in adults, intracranial hypertension is still a concern in pediatrics. There has been a wealth of information with regards to symptomatology, treatment, and outcomes from the IIHTT that will hopefully assist with management in the pediatric population.

aDepartment of Ophthalmology

bDepartment of Neurology, Nationwide Children's Hospital, Columbus, Ohio, USA

Correspondence to Shawn C. Aylward, MD, Division of Child Neurology, Nationwide Children's Hospital, Ohio State University College of Medicine, 700 Children's Drive, Columbus, Ohio 43205, USA. Tel: +1 614 722 4625; fax: +614 722 4633; e-mail:

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