Alqahtani Youssef Ali M, Aljabri Mohammed Fahad, Oshi Mohammed Ahmed Mohammed, Kamal Naglaa M, Elhaj Waleed, Abosabie Sara A, Abosabie Salma As
Department of Child Health, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia.
Neurology Division, Department of Pediatrics, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia.
Clin Med Insights Case Rep. 2023 Feb 27;16:11795476231158509. doi: 10.1177/11795476231158509. eCollection 2023.
In children, idiopathic intracranial hypertension (IIH) is relatively uncommon. It is characterized by an increase in intracranial pressure, in the absence of evidence of underlying brain disease, structural abnormalities, hydrocephalus, or abnormal meningeal improvement. However, very rarely it can occur without papilledema, even though it is the most recognizable clinical sign. Due to this, a delay in diagnosis can lead to severe visual impairments.
We describe a patient with a chronic headache but no papilledema. His neurological and systemic examinations were otherwise unremarkable. A lumbar puncture revealed a high opening pressure of 450 mmHO and normal cerebrospinal fluid (CSF) parameters. Magnetic resonance imaging of the brain revealed only tortuous optic nerves, no parenchymal lesions, and no evidence of venous sinus thrombosis. He required acetazolamide treatment. Our patient's symptoms improved significantly in 2 months with medical treatment, weight loss, and exercise, with no development of papilledema.
There is a wide range of clinical manifestations of IIH, making it difficult to decide when to begin treatment.
儿童特发性颅内高压（IIH）相对少见。其特征是颅内压升高，且无潜在脑部疾病、结构异常、脑积水或脑膜异常的证据。然而，尽管视乳头水肿是最易识别的临床体征，但IIH极少在没有视乳头水肿的情况下发生。因此，诊断延迟可能导致严重视力损害。
我们描述了一名患有慢性头痛但无视乳头水肿的患者。他的神经系统和全身检查无其他异常。腰椎穿刺显示初压为450 mmHO，脑脊液（CSF）参数正常。脑部磁共振成像仅显示视神经迂曲，无实质病变，也无静脉窦血栓形成的证据。他需要乙酰唑胺治疗。经过药物治疗、体重减轻和运动，我们的患者症状在2个月内显著改善，且未出现视乳头水肿。
IIH有广泛的临床表现，难以确定何时开始治疗。
