Children and IH
Chronic IH can occur at any age, but children with chronic IH are a special group. While the current medical literature offers some solid evidence of how children differ from adults in terms of etiology, incidence, presentation of symptoms, and response to treatment, there is still much to learn.
The incidence of idiopathic IH in children is about 1 per 100,000, which is similar to that of the general adult population, but there is an equal distribution between boys and girls under age 10. Gender, therefore, is not considered a factor for children with idiopathic IH.
The incidence of secondary IH in children is currently unknown. The reasons for this lack of a secondary incidence rate are the same as for adults. Since there are no medical diagnostic codes (ICD-9 codes) for secondary IH, the disorder is often recorded under a different diagnosis. It is also frequently misdiagnosed.
Weight is not usually a factor for pre-pubescent children with chronic IH. Secondary causes of intracranial hypertension may also be far more common in children, especially in the youngest.
Medications, such as tetracycline, minocycline and doxycycline used to treat infections and acne, are common secondary causes of intracranial hypertension in children. The use of retinoids, such as isetretinoin (Accutane) or all trans-retinoic acid (used to treat one form of leukemia), as well as excessive vitamin A ingestion, can also cause secondary intracranial hypertension. Symptoms of IH can appear within days of beginning a course of treatment with a particular drug or it may take months to a year before symptoms develop.
Other secondary causes common among children include:
• Growth hormone therapy
• Steroid withdrawal (including topical steroids used in the treatment of eczema)
• The chemotherapy agent all trans-retinoic acid (used for treatment of promyelocytic leukemia)
• Venous sinus thrombosis (cerebral blood clots)
• Post-streptoccal infection (strep throat)
• Meningitis (bacterial or viral)
• Systemic diseases such as lupus, sarcoidosis, Lyme’s disease, Behcet disease
• Severe anemia
• Chiari malformation (congenital or acquired)
Headaches are the most common presenting symptom for children; however, visual changes may initially go unreported. It is especially important to monitor vision in children with chronic IH and treat vision loss because permanent impairment and optic atrophy can occur, in some cases, quite rapidly.
Children with chronic IH face the same medical and surgical treatment options as adults, with the possibility of repeated procedures and accompanying risks. However, for unknown reasons, spontaneous remission of IH in children is also more common than it is in adults.