Journal
JOURNAL OF CHILD NEUROLOGY
Volume 36, Issue 11, Pages 1047-1053Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/08830738211026798
Keywords
fulminant intracranial hypertension; pediatric; papilledema; lumbar drain; CSF shunt
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The study found that temporary lumbar drain with medical therapy may be an effective first approach to managing pediatric fulminant intracranial hypertension, resulting in good clinical outcomes.
Aims: Examine ophthalmologic outcomes and complications of lumbar drain and cerebrospinal fluid shunts in pediatric fulminant intracranial hypertension. Methods: Patients under 21 years of age with a diagnosis of fulminant intracranial hypertension with temporary lumbar drain only, shunt after lumbar drain, and shunt only were included. Parameters investigated include lumbar drain data, medication freedom, time to resolution of papilledema, improvement in cranial nerve palsy, afferent pupillary defects, visual fields, visual acuity, and complications of each intervention. Results: Four patients had temporary lumbar drain, 2 temporary lumbar drain and cerebrospinal fluid shunt, and 3 shunt only. All achieved medication freedom and resolution of papilledema and cranial nerve palsies (if present). Most had resolution of preprocedure afferent pupillary defects. Minor residual visual field deficits occurred in 67%, and all had visual acuity improvement. One patient's lumbar drain dislodged, and one patient had 2 cerebrospinal fluid shunt revisions. Conclusion: Temporary lumbar drain with medical therapy may be a viable first approach to fulminant intracranial hypertension.
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