Intracranial hypotension and hypertension in children and adolescents

Pediatric Intracranial Hypotension and Post-Dural Puncture Headache

Pediatric intracranial hypotension can occur acutely following iatrogenic dural puncture for diagnostic or therapeutic purposes, or chronically from cerebrospinal fluid leak. The incidence of intracranial hypotension in children is not fully known. However, many steps can be taken to reduce the risk of a child developing a post-dural puncture headache. Other causes of intracranial hypotension, such as spontaneous intracranial hypotension or CSF fistulas, are rare and with little pediatric data to guide evaluation and management. This manuscript reviews the risk factors, diagnostic evaluations, and treatments for post-dural puncture headache, as well as a limited discussion of spontaneous intracranial hypotension as it may pertain to children and adolescents.

Patients with pulse-synchronous tinnitus should be suspected to have elevated cerebrospinal fluid pressure

Objective

This study was performed to evaluate the prevalence and clinical importance of elevated cerebrospinal fluid (CSF) pressure among patients with pulse-synchronous tinnitus.

Methods

Nineteen patients underwent height and weight measurements, routine otologic examinations, ear computed tomography, brain magnetic resonance imaging, fundus examination, and tinnitus score assessment. We analyzed the data with Fisher’s exact test, the t-test, and Pearson’s correlation.

Results

The mean age of the 19 patients was 39.2 ± 8.1 years (range, 27–54 years), and the mean body mass index was 22.2 ± 1.6 kg/m² (range, 19.9–24.6 kg/m²). The proportion of patients with elevated CSF pressure was 68%. No significant correlation between the severity of tinnitus and CSF pressure was found. Lumbar puncture and oral administration of diuretics resulted in significant improvement in tinnitus.

Conclusions

If detailed physical and imaging examinations fail to detect the definite cause of pulse-synchronous tinnitus, a routine lumbar puncture should be performed to measure the CSF pressure. Elevated CSF pressure should be suspected in patients with pulse-synchronous tinnitus.

Experts' opinion about the pediatric secondary headaches diagnostic criteria of the ICHD-3 beta

Background

The 2013 International Classification of Headache Disorders-3 was published in a beta version to allow clinicians to confirm the validity of the criteria or suggest improvements based on field studies. The aim of this work was to review the Secondary Headache Disorders and Cranial Neuralgias and Other Headache Disorders sections of ICHD-3 beta data on children and adolescents (age 0–18 years) and to suggest changes, additions, and amendments.

Methods

Several experts in childhood headache across the world applied different aspects of ICHD-3 beta in their normal clinical practice. Based on their personal experience and the available literature on pediatric headache, they made observations and proposed suggestions for the mentioned headache disorders on children and adolescents.

Results

Some headache disorders in children have specific features, which are different from adults that should be acknowledged and considered. Some features in children were found to be age-dependent: clinical characteristics, risks factors and etiologies have a strong bio psychosocial basis in children and adolescents making primary headache disorders in children distinct from those in adults.

Conclusions

Several recommendations are presented in order to make ICHD-3 more appropriate for use in children.

Pediatric Intracranial Hypertension

Investigators from the Ohio State University, Oregon Health and Science University and Rosalind Franklin School of Medicine examined the presenting manifestations, demographics and treatment strategies in children enrolled in the Intracranial Hypertension Registry (IHR).