2025 – PAGE 400 – NEUROLOGY

(DOUBLE TAKE) PSEUDOTUMOR CEREBRI (AKA IDIOPATHIC INTRACRANIAL HYPERTENSION or BENIGN INTRACRANIAL HYPERTENSION)

The symptoms associated with increased intracranial pressure (ICP) predominate for Pseudotumor Cerebri (AKA Idiopathic Intracranial Hypertension or Benign Intracranial Hypertension). These include headache, nausea, vision changes, and bulging fontanelle. Late findings are papilledema and loss of vision. The disease is not benign, and although CT or MRI of the head will not show herniation, a lumbar puncture will show increased intracranial pressure. It can be associated with excessive vitamin A, isotretinoin, tetracycline, and thyroxine. Treatment may require acetazolamide, diuretics, and sometimes even a shunt or a surgical procedure to relieve pressure on the optic nerve.

PEARL: PSEUDO-tumor. Don’t get confused by the word “tumor.” This condition is NOT associated with a mass.

MNEMONIC: (image)

AAAAAAAAAAAAAAAAAAAH!

TENSION HEADACHES

Tension headaches tend to be frontal or band-like headaches. It there is a component of depression, children may be sleeping more and/or having trouble at school. Use acetaminophen or ibuprofen.

MIGRAINE HEADACHES

Migraine headaches are often difficult to diagnose in children, but classically these are severe unilateral headaches associated with nausea, vomiting, photophobia, and/or phonophobia. They can also be associated with auras. First try analgesics like ibuprofen or acetaminophen. Also prescribe rest in a quiet and dark room. If that doesn’t work, try a triptan (like nasal sumatriptan).

PEARL: This is a diagnosis of exclusion. If there is any focal neurologic deficit, or any question in your mind about the diagnosis, do a complete neurologic workup, starting with a CT of the head.

OMINOUS HEADACHES

If you are given the history of an ominous headache that is worse in the mornings or associated with emesis, have a high index of suspicion for something bad, like increased intracranial pressure.