Pediatric emergency medicine trisk 2623 2623
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propranolol, tricyclic antidepressants, cyproheptadine (Periactin), VPA, and
calcium channel blockers. More recent studies of antiepileptic medications have
shown some efficacy in preventing migraine headaches in adult patients,
including gabapentin, topiramate, lamotrigine, and tiagabine.
Clinical Indications for Discharge/Admission. Most patients with migraine can
be successfully managed as outpatients. Admission is reserved for those in whom
continued parenteral therapy is needed to control symptoms. Patients with chronic
or recurrent symptoms requiring prophylactic treatment should be referred to a
neurologist.
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
Goals of Treatment
In addition to pain relief, initial treatment in idiopathic intracranial hypertension
(IIH) is directed at preventing neurologic sequelae.
CLINICAL PEARLS AND PITFALLS
Many children with intracranial hypertension have an identifiable cause.
While papilledema is very commonly seen, some children may present
without papilledema.
Current Evidence
IIH, also called pseudotumor cerebri syndrome, is a poorly understood condition
of increased ICP. It may occur at any age during childhood but is more common
in adolescents, especially in obese individuals. Females are more commonly
affected. A number of other conditions have been reported in association with
IIH; these include anatomic anomalies (cerebral venous abnormalities), infections
(otitis media, mastoiditis, Lyme disease), endocrinologic conditions
(hyperthyroidism, Addison disease), medications (steroid withdrawal, oral
contraceptives, tetracycline, hypervitaminosis A), and mild head trauma.
However, a causal relationship remains unproved, and in most cases of IIH, no
cause is identified. The mechanism of increased ICP in IIH remains unknown,
although several hypotheses have been postulated, including vasogenic brain
edema and impaired reabsorption of cerebrospinal fluid (CSF) by the arachnoid
villi.
Clinical Considerations
