The role of ICP monitoring in paediatric IIH

Harishchandra Lalgudi Srinivasan*, Carla Richetta, Nir Manoim, Anat Bachar Zipori, Shelly I. Shiran, Hadas Meirson, Jonathan Roth, Shlomi Constantini

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Diagnosis of idiopathic intracranial hypertension (IIH) in children is an extrapolation of the guidelines suggested for adult population. Lumbar puncture (LP) plays a crucial role in the diagnosis. The diagnosis of IIH at times is solely dependent on the interpretation of the opening pressure (OP). Unfortunately, LP-OP can vary due circumstantial parameters and therefore may be an unreliable form of intracranial pressure (ICP) measurement. Confirming the diagnosis based (as suggested by guidelines) on LP-OP in a doubtful clinical situation would be inappropriate. The aim of our study was to analyse the reliability of LP-OP and importance of ICP monitoring in situations where diagnosis of IIH was questionable. Methods: Retrospective review of all children with diagnosis of IIH over a 10-year period was conducted. Children who underwent ICP monitoring (ICPM) were selected. We considered 2 LP-OP values—last LP (lLP) and the mean LP (mLP) for analysis. ICPM and LP-OP were compared. Follow-up till last clinic visit was also considered for long-term outcome. Results: Eleven children (male 3; female 8) were included in the study. Mean delay between LP and ICPM was 112.8 days (17–257 days). There was lack of correlation between LP-OP and ICP in 9 children. ICP monitoring refuted the diagnosis of IIH in 80% of children and prevented exposure to unnecessary medical and surgical intervention. There was 1complication with ICPM. In 90% of children, there was no progression of symptoms following a decision based on ICP monitoring on long-term follow-up (mean, 36.5 months). Conclusion: When the diagnosis of IIH is in doubt, LP may be unreliable and formal ICP monitoring is advised.

Original languageEnglish
Pages (from-to)3027-3033
Number of pages7
JournalChild's Nervous System
Volume36
Issue number12
DOIs
StatePublished - Dec 2020
Externally publishedYes

Keywords

  • ICP monitoring
  • IIH
  • Lumbar puncture
  • Opening pressure
  • PTC

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