Secondary intracranial hypertension (pseudotumor cerebri) presenting as post-traumatic headache in mild traumatic brain injury: a case series

• Published in: Child's nervous system Vol. 34; no. 4; pp. 681 - 690
• Main Authors: Sabo, Tonia, Supnet, Charlene, Purkayastha, Sushmita
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2018
• Subjects: Adolescent; Brain Injuries, Traumatic - complications; Brain Injuries, Traumatic - diagnostic imaging; Child; Female; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Neurologic Examination; Neurosciences; Neurosurgery; Original Paper; Post-Traumatic Headache - diagnostic imaging; Post-Traumatic Headache - etiology; Pseudotumor Cerebri - diagnostic imaging; Pseudotumor Cerebri - etiology; Pseudotumor cerebri; Acetazolamide; Intracranial pressure; Post-traumatic headache; Concussion; Idiopathic intracranial hypertension
• ISSN: 0256-7040; 1433-0350
• DOI: 10.1007/s00381-017-3681-x

Background Cerebral edema peaks 36–72 h after moderate traumatic brain injury but thought to be uncommon after mild traumatic brain injury. Post-traumatic headache can develop 48–72 h post-injury, perhaps reflecting the developing cerebral edema. Pseudotumor cerebri can result from various causes, including cerebral edema, and is characterized by increased intracranial pressure, headache, visual, and other common symptoms. Our objective was to report a phenotypically identifiable post-traumatic headache subtype. Case series presentation This case series of six pediatric patients with post-traumatic pseudotumor cerebri was assessed at 48–120 h post-primary injury with new or a change in symptoms such as headache, vision, auditory, balance, and cognition. Clinical findings included slight fever, neck/head pain, papilledema or cranial nerve deficit (6th), and lack of coordination. Elevated cerebral spinal fluid pressure was documented by lumbar puncture, with no infection. Symptoms improved with treatment specific to post-traumatic headache subtype (lumbar puncture, topiramate, or acetazolamide). Conclusions Recognition of specific post-traumatic headache subtypes after mild traumatic brain injury will expedite treatment intervention to lower intracranial pressure and resolve symptoms.