Pediatric Idiopathic Intracranial Hypertension: Clinical Characteristics and the Impact of Obesity and Adolescence

INTRODUCTION: Pediatric idiopathic intracranial hypertension (IIH) is a rare but clinically important condition due to its heterogeneous presentation and risk of permanent visual loss. This study aimed to evaluate the clinical characteristics, neuroimaging findings, treatment approaches, and the influence of obesity and adolescence in pediatric IIH.
METHODS: Pediatric patients aged 2–18 years with IIH followed at a single center were retrospectively reviewed. In accordance with the World Health Organization definition of adolescence, patients aged ≥10 years were classified as adolescents and those aged <10 years as preadolescents.
RESULTS: Thirty-four patients were included, of whom 22 (64.7%) were female. The female-to-male ratio increased from 1.3: 1 in the preadolescent group (n=14) to 3: 1 in the adolescent group (n=20). Obesity was significantly more common among adolescents than preadolescents (45.0% vs. 7.1%, p=0.024). Headache was the most frequent presenting symptom (79.4%), and papilledema was present in all patients. Neuroimaging findings suggestive of raised intracranial pressure were observed in 22 patients (64.7%). No significant differences were identified between groups regarding presenting symptoms, ophthalmologic findings, or neuroimaging characteristics (all p>0.05). All patients were managed conservatively. Median treatment duration was significantly longer in adolescents than in preadolescents (10 [6–12] vs. 6.5 [4–8] months, p=0.001).
DISCUSSION AND CONCLUSION: Despite differences in obesity prevalence and treatment duration, the clinical and radiologic presentation of pediatric IIH remained largely consistent across age groups. These findings support maintaining a high index of suspicion for IIH in preadolescent children without obesity or other recognized risk factors.

Keywords: Idiopathic intracranial hypertension, Pediatrics, Obesity, Adolescence, Papilledema