Persistent Elevation of Opening Pressure Measurements Across Treatment of Pediatric Intracranial Hypertension

Currently no guidelines for repeating a lumbar puncture to guide management in primary intracranial hypertension (PIH) exist. This study aims to examine opening pressure changes in PIH at diagnosis, prior to medication wean, and following medication wean, as well as to examine whether measurements at time of diagnosis differed between those with and without disease recurrence. Forty-two patients were included in this study, 36% were male and mean age at diagnosis of 11.01 years. Treatment duration averaged 9.68 months in those without recurrence and 8.5 months in those with recurrence. Average BMI percentile of patients with disease recurrence was 83.7 and 72.1 in those without recurrence (p = 0.16). Average opening pressure of all patients with opening, pre-wean, and post-wean opening pressure values, was 36.53cm H2O, 30.7cm H2O, and 31.1cm H2O respectively. There was no statistically significant difference in opening pressures across these time points (p = 0.14). The change in opening pressure from diagnosis to post-wean was statistically significant with a reduction of 5.18cm H2O (p= 0.04). There was no statistical difference between change in opening pressure at diagnosis versus post-wean between those with or without recurrence (p= 0.17). This clinical observational study suggests that mean opening pressure measurements in patients with PIH remain elevated both before and after medication wean despite papilledema resolution and patient reported PIH symptoms. Clinically, this suggests that other features such as signs of optic disc edema and symptoms should be used to inform a clinical determination of disease recurrence and treatment course.