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Abstract

Background: Idiopathic intracranial hypertension (IIH), a clinical disorder also known as pseudotumor cerebri, is characterized by increased intracranial pressure of unknown causes. Although it is most commonly observed in young obese women, IIH can also occur in the pediatric population; however, it is exceptionally rare in infancy. Infants do not typically exhibit characteristic signs and symptoms of IIH, making it challenging to diagnose. Additionally, treatment modalities for this disease remain uncertain. Case Description: We report a 8-month-old female admitted to the pediatric emergency department with IIH, to report and emphasize our approach. Our patient presented initially with fever, vomiting and diarrhea and then she developed inability to abduct the left eye. Papilledema was not detected in our patient. Magnetic resonance imaging and lumbar puncture contributed to diagnosis of the patient. Dexamethasone (0.5 mg/kg/day, twice a day) and acetazolamide (5 mg/kg/day) was administered, dexamethasone was stopped at the 48th hour after esotropia had resolved. The patient developed left ptosis in the first month after discharge. Acetazolamide was administered for a duration of five months and was discontinued once the patient's eye findings improved. Conclusions: With a sudden onset of neurological findings in a healthy infant with normal neuroimaging, IIH should be considered in the differential diagnosis and cerebrospinal fluid pressure should be measured. The principles of treatment for this disease are based on adult guidelines, but the efficacy of acetazolamide has also been reported in the pediatric population, like in our case.

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