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Idiopathic intracranial hypertension identified in a child seen in CAMHS

Published online by Cambridge University Press:  02 January 2018

Uma M. Ruppa Geethanath
Affiliation:
Child and Adolescent Psychiatry, Ty Bryn Unit, St Cadoc's Hospital, Lodge Road, Caerleon, Gwent NP18 3XQ, Wales, email: [email protected]
Alka Ahuja
Affiliation:
Ty Bryn Unit, St Cadoc's Hospital
Hilary Lewis
Affiliation:
Royal Gwent Hospital, Wales
Caroline Davies
Affiliation:
Ty Bryn Unit, St Cadoc's Hospital
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Abstract

Type
Columns
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
Copyright © Royal College of Psychiatrists, 2007

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 (Reference KLEINSCHMIDT, DIGRE and HANOVERKleinschmidt et al, 2000; Reference YOURONKOS, PSYCHON and FRYSSIRASYouronkos et al, 2000). There is 13-27% possibility of visual loss if untreated (Reference SOLER, COX and BULLOCKSoler 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, 319324.Google Scholar
SOLER, D., COX, T. & BULLOCK, P. (1998) Diagnosis and management of BIH. Archives of Disease in Childhood, 78, 8994.CrossRefGoogle Scholar
YOURONKOS, S., PSYCHON, F., FRYSSIRAS, S., et al (2000) Idiopathic intracranial hypertension in children. Journal of Child Neurology, 15, 453457.Google Scholar
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