Secondary Intracranial Hypertension in Pediatric Lyme Meningitis

Lyme disease is the most common vector-borne disease in the United States and has been associated with secondary intracranial hypertension. We reviewed 11 pediatric patients with Lyme-associated secondary intracranial hypertension. All patients presented with headache, ten had papilledema, 7 with a rash, and 5 with a cranial nerve palsy. All patients were treated with acetazolamide, and 3 received combination therapy with furosemide. Three patients were considered to have fulminant intracranial hypertension because of the severity in their presenting courses. Two of the fulminant intracranial hypertension patients were treated with a temporary lumbar drain in addition to medications, whereas 1 fulminant intracranial hypertension patient was treated exclusively with medical therapy alone. The addition of a lumbar drain decreased the time to resolution of papilledema compared to medical management alone. Final visual acuity was 20/20 in each eye of all patients, suggesting that a titrated approach to therapy depending on the severity of presentation can result in good visual outcomes in these cases. Additionally, symptoms can recur after medication wean, so patients should be monitored closely with any discontinuation of intracranial pressure lowering medications.

Automated summary

Lyme disease is a common vector-borne disease in the US and can lead to secondary intracranial hypertension. A review of 11 pediatric patients with Lyme-associated secondary intracranial hypertension found that all patients presented with headache, ten had papilledema, seven had a rash, and five had a cranial nerve palsy. Treatment with acetazolamide and, in some cases, combination therapy with furosemide, resulted in good visual outcomes in all patients.