Headache and Visual Symptoms in a Child

Abstract

Clinical presentation: An 11-year-old previously healthy female presented with a two-week history of progressively worsening headaches associated with transient episodes of blurred vision and pulsatile tinnitus. The headaches were diffuse, throbbing, and more pronounced in the morning, occasionally waking her from sleep. There was no history of fever, vomiting, recent infection, head trauma, or medication use. On examination she was overweight (BMI > 95th percentile) and alert, with a mild right sixth-nerve palsy; the rest of the neurological and systemic examination was unremarkable. Brain MRI showed optic-nerve tortuosity, bilateral papillary protrusion, an empty sella, and low-lying cerebellar tonsils, while funduscopy revealed bilateral grade-3 papilledema. Diagnosis: idiopathic intracranial hypertension (IIH), confirmed by an elevated CSF opening pressure (30 cm H2O) with normal CSF composition; the main risk factor was being overweight. Management relies on acetazolamide and weight reduction, with surgical options reserved for refractory cases.