Specific diagnostic work up. Associated or causative Conditions. Minimal diagnostic work up. Brain imaging. HISTORY . IMPORTANT NOTICE: Any prepubertal child and male adolescent has to be considered atypical and secundary intracranial hypertension has to be suspected.
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Associated or causative ConditionsMinimal diagnostic work up
IMPORTANT NOTICE: Any prepubertal child and male adolescent has to be considered atypical and secundary intracranial hypertension has to be suspected.
Medication, including contraceptives?Recent rapid weight gain?Menstruational problems?Current or recent infection?Any chronic illness?Type of seizure?
Exclude intracranial mass lesion, malformation, ventriculomegaly.
Exclude sinus venous thrombosis by MRV in every atypical case, poor treatment response, relapse!
Medical disorders: Addison’s disease; Hypoparathyroidism; Hypo- and hyperthyroidism; Vitamin D deficiency; Chronic obstructive pulmonary disease; Right heart failure with pulmonary hypertension; Sleep apnoea; Renal failure; severe iron deficiency anaemia; Thrombophilia (Antiphospholipid-Syndrome); PCOS, SLE.
Medications:Tetracycline and related compounds; Nitrofuratoin; Chinolone;Vitamin A and related compounds; Anabolic steroids; Corticosteroid withdrawal following prolonged administration (including inhalative steroids); Growth hormone administration in deficient patients; Nalidixic acid, Lithium, Norplant_ levonorgestral implant system
Obstruction to venous drainage:Cerebral venous sinus thrombosis; Jugular vein thrombosis
(Post)infectious: Lyme-disease; post-varicella; ???
Performed during the morning, in lateral decubitus condition, calm child. Sedation if required. Avoid ketamine and inhalitve anaesthetics.
Check CSF opening pressure: >20 cm H2O is abnormal
Check for: Cell count, protein, glucose. Consider infectious work-up.
Consider repeated LP if presentation is suggestive for IIH but pressure is within normal limits, particularly in the young child.
Overweight? Fever? Signs of CNS-infection?Focal neurological signs (suggestive for IIH: sixth nerve palsy)? Reduced level of consciousness?High blood pressure?
Na, Ca, Mg, phosphate, blood gases, BUN, glucose, AST, RBC, WBC, CRP, T3, TSH
More comprehensive work-up is required if secondary intracranial hypertension is suspected (see right column)
Use age adjusted standardised visual field testing.Use Papilledema Grading System Scale.Visus? Neuroophthalmology (VI palsy?).