Intracranial Hypertension and the child at school


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Sometimes called Idiopathic Intracranial Hypertension, benign Intracranial Hypertension or Pseudotumour Cerebri is a rare condition which occurs in about 1 or 2 in 100,000 people.

In children, boys and girls are affected equally, but if the onset is in adult life, the majority of cases are seen in women.

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Intracranial Hypertension and the child at school

  1. 1. 42 Park Road Peterborough PE1 2UQ 01733 555988Intracranial Hypertension and the childat schoolSometimes called Idiopathic Intracranial Hypertension, BenignIntracranial Hypertension or Pseudotumour Cerebri is a rarecondition which occurs in about 1 or 2 in 100,000 people. Inchildren, boys and girls are affected equally, but if the onset isin adult life, the majority of cases are seen in women.Onset can be sudden or insidious; examined, papilloedema (swellingthe cause is not known, but of the disc) is seen: the childalways present are:- should then be referred urgently to a neurologist.a) an abnormality in absorptionor excess production of Other symptoms includecerebrospinal fluid (CSF) leading headaches (often debilitating, oftento a build-up of this fluid in the misdiagnosed as migraine), nauseabrain; or vomiting, problems with balance and spatial awareness, dizziness,b) increased blood volume in the short term memory loss andvessels around the brain; behavioural problems.c) swelling of the brain These symptoms are due to an increase in intracranial pressureIH is often diagnosed after (ICP = pressure inside the head).sight problems lead to the childattending the optician. When the Children with raised ICP may findoptic discs (back of the eyes) are it difficult to cope with previously
  2. 2. Intracranial Hypertension and the childat schoolmanaged tasks and may appear to into the spine which is connected“lose” information previously learnt. to another catheter which drains into the abdomenSome children may leak CSF downthe nose. In practice, the child may undergo frequent shunt revision and mayTreatment need a ventricular peritoneal shunt in addition to, or instead of, the LPBetween 11 - 35% of cases resolve Shunt.spontaneously. The VP shunt has a catheter intoThe first line of treatment is usually the brain connected to a valveby diet (if the child is very overweight) which is, in turn, connected to acombined with drugs. In some tube into the abdomenchildren, two weeks treatment withsteroids is sufficient to re-open the It is impossible to predict whethervenous pathways within the brain a particular shunt will fail, or howso that the IH resolves. often and for how long the child may be hospitalised as a result.Others need repeated lumbarpunctures to remove excess CSF: Even with a fully functioningin children these are done under shunt, some children have severegeneral anaesthetic or heavy headaches and may not managesedation and will mean a few days to attend school full time.out of school. They should be encouraged toSome people need the CSF attend at the time of day whendiverted by means of a surgically they feel well and the timeinserted shunt. gradually increased.In theory, a lumbar peritoneal (LP) When in school, there is little thatshunt is the shunt of choice. the shunts will prevent them from doing. They can swim, play in theThe LP shunt has a catheter placed playground, run, jump, do PE. A
  3. 3. child with a LP shunt should not If a child experiences thesedo stretching or twisting exercises, problems, their friends shouldnor should he/she somersault, do be encouraged to help the childforward rolls or hang upside down overcome them. If the child realisesfor any period. that they will not hit their head on the sky (prove this by reaching overIf he/she has an injury to the back him/her), or fall through the openor abdomen and becomes unwell, treads (a friend could “demonstrate”damage to the shunt should be or measure the gaps), the child willconsidered, although this is very be more confident.rare. Friendships are very important forWith a VP shunt, care should children with IH as their naturalbe taken not to “grab” the child inclination is often to be “loners”,round the neck. So he/she would so every effort must be taken tobe unadvised to take part in judo, encourage friendships alreadyrugby scrums etc. made and appropriate new friendships. This is essential if theCare should also be taken after a child misses a lot of school or isblow to the head or abdomen (eg only in school for part of the day.from a football): if the child doesnot recover, shunt damage must Finally, all children with shunts maybe considered. Again, this is, be prone to dehydration in the heatfortunately, very rare. (more so than their peers) so will need frequent, even hourly drinksSome children with spatial problems of clear fluid (ie water) but not drinksmay find it difficult to go outside containing caffeine.if the sky is cloudless and theycannot see where it is in relation They may also have difficulty in bodyto themselves. Going into a room temperature control, so on very hotwith differing ceiling levels or with days should be encouraged to playbeams may have the same effect. in the shade when outside, and sitSo may open tread staircases and in a cool part of the room whenhighly patterned floor coverings. indoors.
  4. 4. Further informationFor further information on IH, pleasesee information sheet IntracranialHypertension, or contact the Shineon 01733 555988 to speak to aSpecialist Adviser.Help usShine relies on people’s generosity and support so we can help our clientswho depend on us for help and advice - people with hydrocephalus,spina bifida, their families and carers. To donate to Shine please or call 01733 421329.This information has been produced by Shine’s medical advisers andapproved by Shine’s Medical Advisory Committee of senior medicalprofessionals.Shine - Registered charity no.249338To see our full range of information sheets and to find out how to donateto Shine please visit