L’hypertension intracrânienne idiopathique (HICI) peut entraîner des séquelles visuelles. Notre étude avait pour but d’analyser les traitements et le pronostic de cette affection dans une série pédiatrique et de les comparer aux données de la littérature.

Étude rétrospective monocentrique incluant 18 patients suivis entre 1995 et 2009. L’âge moyen était de 10ans. Les résultats des examens cliniques et ophtalmologiques en début et fin de traitement ont été recueillis. Pour chaque traitement médical, la dose et la durée du traitement ont été précisées.

L’acétazolamide a été proposé en première intention chez 16 patients à une dose moyenne de 11,2mg/kg par j pour une durée moyenne de 2,5 mois. Ce traitement a été efficace dans 10 cas sur 14 traitements analysables. La corticothérapie a été le traitement de première intention pour 4 patients et systématiquement le traitement de seconde intention en cas d’échec de l’acétazolamide. Il n’y a pas eu de séquelle visuelle pour les 13 patients analysables. Un patient est toujours en cours de traitement. Trois patients ont présenté des récidives d’HICI.

L’acétazolamide a été utilisé à faible dose dans notre étude. En l’absence d’efficacité initiale, la dose peut être augmentée jusqu’à 2g/j chez l’enfant et le traitement doit être prolongé afin de limiter le recours à la corticothérapie.

Le traitement pédiatrique de l’HICI implique d’utiliser de l’acétazolamide à bonne dose en première intention. Le pronostic est meilleur qu’à l’âge adulte avec moins de séquelles visuelles.

Idiopathic intracranial hypertension (IIH) may cause severe visual loss due to the optic nerve damage. Routine management involves mainly medical treatment. The aim of this study was to improve diagnosis and management of IIH in children.

The medical records of all patients with definite IIH seen at the children’s hospital of Toulouse between 1995 and 2009 were reviewed. Cases of secondary intracranial hypertension were included because they did not present any cerebral lesions and underwent a similar therapeutic approach. The clinical and ophthalmological data at the beginning and at the end of their treatment was collected.

Eighteen children were included in this study. The average age was 10 years and the sex-ratio was equal to 1. There were 3 cases of secondary idiopathic intracranial hypertension in this pediatric group. The main features encountered were headache (15 children) and diplopia (8 children). Abnormal neurological examination was found for 11 patients with abducens nerve paresis in 8 cases, rachialgia in 6 cases, and neurogenic pains (neuralgia, dysesthesia, paresthesia, hyperesthesia) in the other cases. Papilledema was noted in 16 patients. At the initial phase, loss of visual acuity was documented in 6 patients and altered visual field in nine patients. All patients had a medical treatment. When recurrence occurred, each new treatment was documented, for a total of 23 treatments analyzed. Lumbar puncture was the only treatment for 2 patients. In 16 cases, first-line treatment was acetazolamide and it was the second choice in 1 case, with an average dosage of 11.2mg/kg and a mean duration of 2.5 months (15 treatments could be analyzed). This treatment was effective in 11 cases out of 15. Steroids were the initial treatment in 4 cases and second-line treatment in 4 cases (after failed acetazolamide therapy). The dosage was 1.5–2mg/kg for a mean duration of 1.5 months (6 treatments could be analyzed). This treatment was effective in 5 patients out of 6. One patient had dual therapy. No surgical procedure was necessary in this pediatric cohort. Three patients presented relapses of IIH. The outcome was good with no residual visual impairment in the 13 patients analyzed. One patient was still under medication.

Therapeutic management of IIH in a pediatric population is essentially medical, in some cases limited to lumbar puncture. The first-line treatment is acetazolamide, but this study shows that low doses and short duration are usually chosen. Doses must be increased and treatment prolonged to avoid the use of corticosteroids as a second-line treatment and prevent possible relapses that require close monitoring of visual function.

The visual prognosis is generally better for this age group compared to adults and no risk factors for visual sequelae were identified. A standardized protocol for management of IIH was proposed.