Idiopathic intracranial hypertension – differential diagnosis and presentation of cases

Abstract

Idiopathic intracranial hypertension (IIH) is an important but rare cause of headache in childhood. The clinical manifestation of IIH is non-specific and includes headache, nausea, vomiting, visual disturbances such as diplopia or blurred vision.
The diagnosis of IIH is a diagnosis of exclusion – it is necessary to exclude space-occupying brain lesion, processes leading to blockage of cerebrospinal fluid absorption and communicating hydrocephalus, deep vein thrombosis, diffuse or focal cerebral edema and processes leading to increased cerebrospinal fluid secretion. The article presents cases of children with clinic of increased intracranial pressure (cases of idiopathic intracranial hypertension, acute disseminated encephalomyelitis, cerebral venous thrombosis, brain tumors), which illustrate the difficulties in diagnosis. In the presence of headache, nausea, vomiting, especially if paresis of n. abducens is presented, timely ophthalmoscopy and imaging are required. When papilledema is established, it is necessary to exclude space-occupying brain lesions and other causes of secondary intracranial hypertension. With a normal imaging, timely and sufficient anti-edema therapy is performed, which is of prognostic importance for normalization and preservation of vision.