![]() Most cases occurred after dose was increased due to persistently elevated TSH levels.Thyroxine is a regulator of sodium transport that may alter CSF dynamics. Corticosteroid withdrawal in pediatric patients with IBD. ![]() ![]() Mechanism unknown, but it has been hypothesized that increased levels of vasopressin in these patients may cause increased cerebral volume leading to elevated ICP.In one large study, occurrence of IIH was 100X greater in group treated with growth hormone vs.Proposed mechanism: GH crosses blood-brain barrier to increase local levels of IGF-1 which increases CSF production from choroid plexus.Usually resolves with cessation of GH therapy (can resume at a lower dose as risk of IIH appears to be dose-dependent).Conditions such as obesity, Turner syndrome, chronic renal failure, Prader-Willi, and delayed puberty may increase the risk of IIH in this setting.Decreased CSF reabsorption via arachnoid granulations.Research regarding the role of aquaporin 4 channels regulating cerebral water content is ongoing.Possibly secondary to transverse sinus stenosis (cause/effect relationship with IIH and stenosis is unclear).Presenting symptoms: headache, tinnitus, visual changes (blurred vision, visual loss, photophobia).Patients may also present with other signs of increased ICP: vomiting, altered behavior, decreased level of consciousness, macrocephaly.Headache is the main complaint among children (62-91% of cases).However, some children may not complain of headache (too young to articulate or not having headaches).Young patients with IIH who are not experiencing headaches tend to have more neurologic and visual signs at presentation and have a worse prognosis.Headache may be warning sign of elevated ICP and impending visual loss.Loss of visual acuity is seen in 6-20% of pediatric cases at presentation.Intracranial space-occupying lesion (tumor, abscess).Cranial nerve palsies (CN VI is most common, although III, VII, IX, and XII have also been reported).Visual field loss is seen in up to 91% of cases.
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