The role of ICP monitoring in paediatric IIH

• Published in: Child's nervous system 2020-12, Vol.36 (12), p.3027-3033
• Main Authors: Lalgudi Srinivasan, Harishchandra, Richetta, Carla, Manoim, Nir, Zipori, Anat Bachar, Shiran, Shelly I, Meirson, Hadas, Roth, Jonathan, Constantini, Shlomi
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Neurosciences; Neurosurgery; Original Article
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-020-04618-2

Introduction Diagnosis of idiopathic intracranial hypertension (IIH) in children is an extrapolation of the guidelines suggested for adult population. Lumbar puncture (LP) plays a crucial role in the diagnosis. The diagnosis of IIH at times is solely dependent on the interpretation of the opening pressure (OP). Unfortunately, LP-OP can vary due circumstantial parameters and therefore may be an unreliable form of intracranial pressure (ICP) measurement. Confirming the diagnosis based (as suggested by guidelines) on LP-OP in a doubtful clinical situation would be inappropriate. The aim of our study was to analyse the reliability of LP-OP and importance of ICP monitoring in situations where diagnosis of IIH was questionable. Methods Retrospective review of all children with diagnosis of IIH over a 10-year period was conducted. Children who underwent ICP monitoring (ICPM) were selected. We considered 2 LP-OP values—last LP ( lLP ) and the mean LP ( mLP ) for analysis. ICPM and LP-OP were compared. Follow-up till last clinic visit was also considered for long-term outcome. Results Eleven children (male 3; female 8) were included in the study. Mean delay between LP and ICPM was 112.8 days (17–257 days). There was lack of correlation between LP-OP and ICP in 9 children. ICP monitoring refuted the diagnosis of IIH in 80% of children and prevented exposure to unnecessary medical and surgical intervention. There was 1complication with ICPM. In 90% of children, there was no progression of symptoms following a decision based on ICP monitoring on long-term follow-up (mean, 36.5 months). Conclusion When the diagnosis of IIH is in doubt, LP may be unreliable and formal ICP monitoring is advised.