Pediatric Idiopathic Intracranial Hypertension: Clinical Presentations, Risk Factors, and Prognostic Indicator

Background: Idiopathic intracranial hypertension (IIH) is characterized by elevated cerebrospinal fluid pressure without space-occupying lesions, infections, or alterations in brain parenchyma. Diagnosing IIH in children poses a significant challenge for pediatricians, given the often nonspecific nature of clinical signs and symptoms. Objectives: Our study aims to evaluate the clinical presentations and potential risk factors among pediatric individuals diagnosed with IIH, considering the limited research in this particular domain. Methods: Clinical data from pediatric patients diagnosed with IIH who sought care at Tehran's primary referral children's hospitals were collected from 2013 to 2021, spanning eight years. These patients were subsequently contacted to follow up on the presence of persistent headaches and visual problems. Detailed records of their initial signs and symptoms were documented. To identify prognostic factors associated with persistent headaches and visual problems in pediatric IIH patients, binary logistic regression analysis was conducted. Results: A total of 81 pediatric patients were included in the study, with a mean age of 13.56 +/- 4.404 years at the time of their IIH diagnosis. The most frequently reported clinical symptom among these patients was headache, observed in 85.2% of cases, followed by diplopia (50.6%), visual impairment (46.9%), and nausea with/without vomiting (44.4%). Furthermore, a substantial proportion of the patients were underweight (weight percentiles < 3). Our analysis showed that male patients and those without strabismus experienced significantly more recurrent episodes of IIH (P = 0.013 and P = 0.013, respectively). Notably, recurrent episodes and higher weight percentiles emerged as predictive factors for future persistent visual problems within our study population (P = 0.032 and P = 0.045, respectively). Conclusions: Recurrence of IIH was significantly less in female patients and those with strabismus. Additionally, we found that both lower and higher weight percentiles, as well as the occurrence of recurrent episodes, served as predictive factors for the development of persistent visual problems. However, our model could not predict persistent headaches.