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The role of ICP monitoring in paediatric IIH

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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.

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Fig. 1

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Abbreviations

IIH:

Idiopathic intracranial hypertension

PTC:

Pseudotumor cerebri

LP:

Lumbar puncture

OP:

Opening pressure

ICP:

Intracranial pressure

ICPM:

Intracranial pressure monitoring

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Acknowledgements

We would like to thank Dr. Martin Schumann, Ruhr-Universität Bochum, for reviewing our paper and providing his valuable opinion.

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Authors and Affiliations

  1. Department of Paediatric Neurosurgery, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, 6423609, Tel Aviv, Israel

    Harishchandra Lalgudi Srinivasan, Carla Richetta, Jonathan Roth & Shlomi Constantini

  2. University of Pavia, Pavia, Italy

    Nir Manoim

  3. Ophthalmology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel

    Anat Bachar Zipori

  4. Department of Radiology, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Shelly I Shiran

  5. Pediatric Neurology Unit, Tel Aviv Sourasky Medical Center, Sackler faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Hadas Meirson

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  1. Harishchandra Lalgudi Srinivasan
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Correspondence to Harishchandra Lalgudi Srinivasan.

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Lalgudi Srinivasan, H., Richetta, C., Manoim, N. et al. The role of ICP monitoring in paediatric IIH. Childs Nerv Syst 36, 3027–3033 (2020). https://doi.org/10.1007/s00381-020-04618-2

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