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Idiopathic intracranial hypertension identified in a child seen in CAMHS

Ty Bryn Unit, St Cadoc’s Hospital, Lodge Road, Caerleon, Gwent NP18 3XQ, Wales, email: geeth70{at}hotmail.com

Alka Ahuja, Consultant Child and Adolescent Psychiatrist

Ty Bryn Unit, St Cadoc’s Hospital

Hilary Lewis, Consultant Paediatrician

Royal Gwent Hospital, Wales

Caroline Davies, Occupational Therapist

Ty Bryn Unit, St Cadoc’s Hospital

A 13-year-old was seen in child and adolescent mental health services (CAMHS) for school refusal, extreme separation anxiety, temper tantrums, headache, nausea, vomiting, lethargy, and aches and pains. She was overweight, bullied in school and had a past history of reflux heartburn and psychosomatic complaints for 2-3 years, for which she had been seeing paediatricians.

During her contact with CAMHS therapeutic group, she was isolated and difficult to engage. She was regressed in behaviour and relied a lot on her mother. Her family all along suspected an unidentified organic condition.

With the emergence of vision problems, her general practitioner referred her again to the paediatric team. Idiopathic intracranial hypertension was diagnosed and subsided after treatment with acetazolamide and lumbar punctures. She still has headaches and other non-specific symptoms.

It is known that idiopathic intracranial hypertension is a rare self-limiting condition generally lasting less than 12 months, and in children can present with psychological and non-specific symptoms (Kleinschmidt et al, 2000; Youronkos et al, 2000). There is 13-27% possibility of visual loss if untreated (Soler et al, 1998).

In this patient, given the long history of psychosomatic symptoms pre-dating the onset and persisting after treatment of the idiopathic intracranial hypertension, it is likely to have been a coincidental finding.

This patient illustrates that physical illnesses may arise in children with psychological problems and our dilemma in deciding how far to investigate non-specific symptoms, balancing against the risk of reinforcing somatisation. Regular joint working and consultation between CAMHS, educational services and paediatricians in such complex cases may be a way of sharing knowledge, identifying things early and improving patient care.

References

KLEINSCHMIDT, J. J., DIGRE, K. B. & HANOVER, R. (2000) Idiopathic intracranial hypertension: relationship to depression, anxiety and quality of life. Neurology, 55, 319 -324.

SOLER, D., COX, T. & BULLOCK, P. (1998) Diagnosis and management of BIH. Archives of Disease in Childhood, 78, 89 -94.[Free Full Text]

YOURONKOS, S., PSYCHON, F., FRYSSIRAS, S., et al (2000) Idiopathic intracranial hypertension in children. Journal of Child Neurology, 15, 453 -457.[Abstract/Free Full Text]

This Article Full Text (PDF) Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Geethanath, U. M. R. Articles by Davies, C. Search for Related Content PubMed Articles by Geethanath, U. M. R. Articles by Davies, C.