Asymptomatic Idiopathic Intracranial Hypertension in Young Children

Presenting symptoms of idiopathic intracranial hypertension are known to vary with age. Older children may complain of headache, neck pain, diplopia, intracranial noises, or transient visual obscurations. Younger children may present with apathy or irritability. This report describes three young children with no obvious relevant symptoms in whom papilledema was newly found on routine follow-up eye examination for unrelated problems. At presentation, all had early papilledema with negative cranial neuroimaging studies. All remained apparently asymptomatic, but the papilledema progressed. Sedated lumbar puncture showed elevated cerebrospinal fluid pressure in all three. Two were felt to have truly idiopathic intracranial hypertension, whereas the third had jugular venous obstruction. The papilledema responded to treatment with either acetazolamide or furosemide in all three. An apparent lack of symptoms does not rule out chronic increased intracranial pressure in young children. (J Child Neurol 2002;17:239-241).