Sometimes called Idiopathic Intracranial Hypertension, benign Intracranial Hypertension or Pseudotumour Cerebri is a rare condition which occurs in about 1 or 2 in 100,000 people. In children, boys and girls are affected equally, but if the onset is in adult life, the majority of cases are seen in women.

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Intracranial Hypertension and the child
at school
Sometimes called Idiopathic Intracranial Hypertension, Benign
Intracranial Hypertension or Pseudotumour Cerebri is a rare
condition which occurs in about 1 or 2 in 100,000 people. In
children, boys and girls are affected equally, but if the onset is
in adult life, the majority of cases are seen in women.
Onset can be sudden or insidious; examined, papilloedema (swelling
the cause is not known, but of the disc) is seen: the child
always present are:- should then be referred urgently to
a neurologist.
a) an abnormality in absorption
or excess production of Other symptoms include
cerebrospinal fluid (CSF) leading headaches (often debilitating, often
to a build-up of this fluid in the misdiagnosed as migraine), nausea
brain; or vomiting, problems with balance
and spatial awareness, dizziness,
b) increased blood volume in the short term memory loss and
vessels around the brain; behavioural problems.
c) swelling of the brain These symptoms are due to an
increase in intracranial pressure
IH is often diagnosed after (ICP = pressure inside the head).
sight problems lead to the child
attending the optician. When the Children with raised ICP may find
optic discs (back of the eyes) are it difficult to cope with previously

2. Intracranial Hypertension and the child
at school
managed tasks and may appear to into the spine which is connected
“lose” information previously learnt. to another catheter which drains
into the abdomen
Some children may leak CSF down
the nose. In practice, the child may undergo
frequent shunt revision and may
Treatment need a ventricular peritoneal shunt
in addition to, or instead of, the LP
Between 11 - 35% of cases resolve Shunt.
spontaneously.
The VP shunt has a catheter into
The first line of treatment is usually the brain connected to a valve
by diet (if the child is very overweight) which is, in turn, connected to a
combined with drugs. In some tube into the abdomen
children, two weeks treatment with
steroids is sufficient to re-open the It is impossible to predict whether
venous pathways within the brain a particular shunt will fail, or how
so that the IH resolves. often and for how long the child
may be hospitalised as a result.
Others need repeated lumbar
punctures to remove excess CSF: Even with a fully functioning
in children these are done under shunt, some children have severe
general anaesthetic or heavy headaches and may not manage
sedation and will mean a few days to attend school full time.
out of school.
They should be encouraged to
Some people need the CSF attend at the time of day when
diverted by means of a surgically they feel well and the time
inserted shunt. gradually increased.
In theory, a lumbar peritoneal (LP) When in school, there is little that
shunt is the shunt of choice. the shunts will prevent them from
doing. They can swim, play in the
The LP shunt has a catheter placed playground, run, jump, do PE. A

3. child with a LP shunt should not If a child experiences these
do stretching or twisting exercises, problems, their friends should
nor should he/she somersault, do be encouraged to help the child
forward rolls or hang upside down overcome them. If the child realises
for any period. that they will not hit their head on
the sky (prove this by reaching over
If he/she has an injury to the back him/her), or fall through the open
or abdomen and becomes unwell, treads (a friend could “demonstrate”
damage to the shunt should be or measure the gaps), the child will
considered, although this is very be more confident.
rare.
Friendships are very important for
With a VP shunt, care should children with IH as their natural
be taken not to “grab” the child inclination is often to be “loners”,
round the neck. So he/she would so every effort must be taken to
be unadvised to take part in judo, encourage friendships already
rugby scrums etc. made and appropriate new
friendships. This is essential if the
Care should also be taken after a child misses a lot of school or is
blow to the head or abdomen (eg only in school for part of the day.
from a football): if the child does
not recover, shunt damage must Finally, all children with shunts may
be considered. Again, this is, be prone to dehydration in the heat
fortunately, very rare. (more so than their peers) so will
need frequent, even hourly drinks
Some children with spatial problems of clear fluid (ie water) but not drinks
may find it difficult to go outside containing caffeine.
if the sky is cloudless and they
cannot see where it is in relation They may also have difficulty in body
to themselves. Going into a room temperature control, so on very hot
with differing ceiling levels or with days should be encouraged to play
beams may have the same effect. in the shade when outside, and sit
So may open tread staircases and in a cool part of the room when
highly patterned floor coverings. indoors.

4. Further information
For further information on IH, please
see information sheet Intracranial
Hypertension, or contact the Shine
on 01733 555988 to speak to a
Specialist Adviser.
Help us
Shine relies on people’s generosity and support so we can help our clients
who depend on us for help and advice - people with hydrocephalus,
spina bifida, their families and carers. To donate to Shine please visit
www.shinecharity.org.uk or call 01733 421329.
This information has been produced by Shine’s medical advisers and
approved by Shine’s Medical Advisory Committee of senior medical
professionals.
Shine - Registered charity no.249338
To see our full range of information sheets and to find out how to donate
to Shine please visit www.shinecharity.org.uk