New criteria for diagnosis of pediatric idiopathic intracranial hypertension

In one of the first major reviews of pediatric idiopathic intracranial hypertension (IIH) in 15 years, Lubaina M. Rangwala, MD, and Grant T. Liu, MD, propose that it's time to create new diagnostic criteria for younger children.

Recent studies have demonstrated that pediatric IIH appears to be increasing among adolescent children, in parallel with the increasing incidence of obesity in the overall population.

The authors distinguish between two forms of pediatric IIH:

• Younger pre-pubertal children. In younger children, the condition occurs more commonly in boys and non-obese children, and is associated with several new etiologies, including recombinant growth hormone and all-trans-retinoic acid, used to treat children with acute promyelocytic leukemia. In other cases of pre-pubescent IIH, the etiology for elevation of intracranial pressure is unclear. 
• Adolescents. In older children, the clinical picture is similar to that of adults, occurring more frequently in females and the obese.

As a result, the authors propose using the onset of puberty to distinguish between the two forms of pediatric IIH. The new criteria is a modification of the published standard criteria for IIH in adults.

The new criteria are: Children should have signs or symptoms consistent with elevated intracranial pressure, be prepubertal, have normal sensorium, can have reversible cranial nerve palsies, and have an opening cerebrospinal fluid pressure greater than 180 mm H2O if younger than age 8 and papilledema is present, but greater than 250 mm H20 if age 8 or older or less than 8 without papilledema.