Is Neuroradiological Imaging Sufficient for Exclusion of Intracranial Hypertension in Children? Intracranial Hypertensio
There are still many important questions about algorithms and clinical scenarios in the context of children with clinical intracranial hypertension symptoms (IHS) without radiological findings. Such conditions could appear in different clinical situations
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Abstract There are still many important questions about algorithms and clinical scenarios in the context of children with clinical intracranial hypertension symptoms (IHS) without radiological findings. Such conditions could appear in different clinical situations, including slit ventricle syndrome, overdrainage syndrome, normal volume hydrocephalus, or idiopathic intracranial hypertension. Many articles have defined specific treatment strategies for various forms of IHS, including ventriculoperitoneal shunting, medication for shunt-related migraine, steroids, and valve upgrades with antisiphoning devices or programmable systems. This study is an attempt to define the proper diagnostic procedures and treatment options for patients with various forms of IHS without evident neuroradiological findings. The authors discuss possible pathological mechanisms leading to IHS in the pediatric population. The authors present six children treated in their center. All of the children presented clinical manifestation of intracranial hypertension without evident neuroradiological findings in CT and/ or MRI examinations. In three cases, the final diagnosis was slit ventricle syndrome; in two cases, normal volume hydrocephalus; in another case, idiopathic intracranial hypertension. The treatment options included short-term steroid (dexamethasone) administration and ventriculoperitoneal shunting using programmable systems. In one case of idiopathic intracranial hypertension, ICP monitoring was also performed. The authors discuss possible diagnostic and treatment strategies for the aforementioned cases. There are still many controversies about management of children with clinical symptoms of intracranial hypertension that are not confirmed in neuroimaging. It seems that our understanding of intracranial hypertension in the pediatric population is not nearly as sophisticated or complete as we might have imagined. Ventriculoperitoneal shunting with antisiphoning devices and/or short-term dexamethasone administration seem to be the best treatment options in these cases.
D. Larysz () and P. Larysz, Division of Pediatric Neurosurgery, Medical University of Silesia, Katowice, Ul. Medykow 16, Katowice 40-752, Poland e-mail: [email protected] A. Klimczak and M. Mandera Division of Pediatric Neurosurgery, Medical University of Silesia, Katowice, Ul. Medykow 16, Katowice 40-752, Poland
Keywords Hydrocephalus • slit ventricle syndrome • children • neuroimaging
Background and Purpose There are still controversies about diagnostic procedures and therapeutic management of children admitted to hospitals with clinical symptoms of intracranial hypertension syndrome (IHS) but without any, or with very slight, evidence of IHS in neuroimaging. Such conditions could appear in different clinical situations, including slit ventricle syndrome (SVS), overdrainage syndrome, normal volume hydrocephalus, or idiopathic intracranial hypertension. Many articles have defined specific forms of treatment for a variety of specific forms of IHS, including ve
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