J Korean Ophthalmol Soc.  2010 Sep;51(9):1292-1297. 10.3341/jkos.2010.51.9.1292.

A Case of Bilateral Papilledema and Visual Field Defect in Pediatric Idiopathic Intracranial Hypertension

• Choy YJ
• Ahn YM
• Park SE

• KMID: 2122300
• DOI: http://doi.org/10.3341/jkos.2010.51.9.1292

Abstract

PURPOSE
To report a case of bilateral papilledema and visual field defect in pediatric idiopathic intracranial hypertension.
CASE SUMMARY
The 5-year-old female patient was admitted to the hospital, complaining of headache and vomiting of 3 weeks duration. After admission, she complained of diplopia. The uncorrected visual acuity was 0.3 in the right eye and 0.8 in the left. An alternative prism cover test showed approximately 35 PD esotropia, with a -2 abduction limitation of both eyes. Fundus examination showed bilateral papilledema and peripapillary retinal hemorrhages. No abnormality was found in the MRI and CT, symptoms of headache, vomiting, bilateral papilledema, and esotropia with normal neurologic examination. Therefore, she was diagnosed with pediatric idiopathic intracranial hypertension. In Humphrey visual field test, MD was -14.15 dB in right and -16.58 dB in the left eye. Also, the general sensitivity of visual field decreased. Acetazolamide (Diamox(R)) was given orally for 30 days. Forty-four days after the initial visit, peripapillary retinal hemorrhages and vessel tortuosity decreased. Furthermore, visual acuity improved to 1.0 in the right eye and 0.9 in the left. The esotropia reduced to 5 PD, and MD improved to -4.83 dB in the right eye and -5.24 dB in the left.

Keyword

Acetazolamide; Papilledema; Pediatric idiopathic intracranial hypertension

MeSH Terms

Acetazolamide
Diplopia
Esotropia
Eye
Female
Glycosaminoglycans
Headache
Humans
Neurologic Examination
Papilledema
Preschool Child
Pseudotumor Cerebri
Retinal Hemorrhage
Visual Acuity
Visual Field Tests
Visual Fields
Vomiting
Acetazolamide
Glycosaminoglycans

Figure

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  Figure 1. (A), (B) The fundus photographs of the pediatric idiopathic intracranial hypertension patient at presentation. Both eyes show papilledema, peripapillary retinal hemorrhages, disc blurring and vessel tortuosity. (C), (D) The fundus photographs of the patient after 30 days from the initial visit. Both eyes show decreased peripapillary retinal hemorrhages and vessel tortuosity. But, papilledema seems to be stationary. (E), (F) The fundus photographs of the patient after 4 months from the initial visit. Papilledema of both eyes almost resolved.

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  Figure 2. The visual evoked potential of the pediatric idiopathic intracranial hypertension patient at presentation. (A) Pattern visual evoked potential (VEP), (B) Goggle VEP: show normal pattern of visual evoked potential.

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  Figure 3. The brain magnetic resonance imaging (MRI) of the pediatric idiopathic intracranial hypertension patient at presentation. There were no specific findings like cerebral edema, brain tumor, and cerebral vascular abnormalities. According to flattening of the posterior sclera (white arrows), high cerebrospinal pressure was suggested.

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  Figure 4. (A), (B) Automated Humphrey visual field test of the pediatric idiopathic intracranial hypertension patient at presentation. The visual field test demonstrates enlarged physiologic scotoma and irregular peripheral visual field defects. (C), (D) The visual field tests of the patient after 44 days from the initial visit. The visual field tests show improved peripheral visual field defects.

Reference

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