Minimal%20diagnostic%20work%20up

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Minimal diagnostic work up
Specific diagnostic work up
Associated or causative Conditions
HISTORY
Brain imaging
IMPORTANT NOTICE Any prepubertal child and male
adolescent has to be considered atypical and
secundary intracranial hypertension has to be
suspected.
Medication, including contraceptives?Recent
rapid weight gain?Menstruational
problems?Current or recent infection?Any
chronic illness?Type of seizure?
Exclude intracranial mass lesion, malformation,
ventriculomegaly. Exclude sinus venous thrombosis
by MRV in every atypical case, poor treatment
response, relapse!
Medical disorders Addisons disease
Hypoparathyroidism Hypo- and hyperthyroidism
Vitamin D deficiency Chronic obstructive
pulmonary disease Right heart failure with
pulmonary hypertension Sleep apnoea Renal
failure severe iron deficiency anaemia
Thrombophilia (Antiphospholipid-Syndrome) PCOS,
SLE. Medications Tetracycline and related
compounds Nitrofuratoin Chinolone Vitamin A
and related compounds Anabolic steroids
Corticosteroid withdrawal following prolonged
administration (including inhalative steroids)
Growth hormone administration in deficient
patients Nalidixic acid, Lithium, Norplant_
levonorgestral implant system Obstruction to
venous drainageCerebral venous sinus
thrombosis Jugular vein thrombosis (Post)infectio
us Lyme-disease post-varicella ???
Lumbar puncture
Clinical examination
Performed during the morning, in lateral
decubitus condition, calm child. Sedation if
required. Avoid ketamine and inhalitve
anaesthetics. Check CSF opening pressure gt20
cm H2O is abnormal Check for Cell count,
protein, glucose. Consider infectious work-up.
Consider repeated LP if presentation is
suggestive for IIH but pressure is within normal
limits, particularly in the young child.
Overweight? Fever? Signs of CNS-infection?Focal
neurological signs (suggestive for IIH sixth
nerve palsy)? Reduced level of
consciousness?High blood pressure?
Laboratory
Na, Ca, Mg, phosphate, blood gases, BUN, glucose,
AST, RBC, WBC, CRP, T3, TSH
Ophthalmology
More comprehensive work-up is required if
secondary intracranial hypertension is suspected
(see right column)
Use age adjusted standardised visual field
testing.Use Papilledema Grading System
Scale.Visus? Neuroophthalmology (VI palsy?).