Neurofluid (clinical)

Neurofluid (clinical): pediatric low ICP syndrome

Koichi Takahashi

Department of Neurosurgery, Sanno Hospital

ABSTRACT

Introduction

Low intracranial pressure (ICP) syndrome has often been considered a problem in adults, but it also affects younger patients. This study analyzed the clinical features of pediatric low ICP syndrome.

Material & Methods

Two hundred seventy-seven patients (133 boys, 144 girls) with low ICP syndrome that had onset earlier than the age of 15 years were investigated for causes, outcomes, and clinical features.

Results

Of the 277 patients, 73 (26.4%) were capable of only limited self-care, and 75 (27.1%) were completely disabled. A total of 148 (53.4%) patients could not go to school before epidural blood patch (EBP). After EBP,  255 (92.1%) of the patients recovered sufficiently for school attendance. Complete recovery was seen in 101 cases (36.5%).

Conclusions

Low ICP syndrome is not yet well recognized, particularly in children and adolescents. Some children were diagnosed as having autonomic nervous system dysfunction, orthostatic dysregulation, Barré-Liéou syndrome, postural tachycardia syndrome, or depression. Although some definite therapies, such as counseling, analgesics, tranquilizers, or antiepileptic drugs were administered, these symptoms persisted chronically or progressed daily. If patients experience related symptoms such as intractable headache, low ICP syndrome should be considered in the differential diagnosis.

These results demonstrated that EBP was effective for younger patients and alleviated not only headache but also motor dysfunction, visual and/or hearing impairment, higher brain dysfunction, taste abnormality, and autonomic nervous system dysfunction; however, the mechanisms underlying the therapeutic effect of EBP remain to be clarified. Further research on cerebrospinal fluid dynamics and function, including studies regarding neurofluids, is necessary.