Idiopathic intracranial hypertension in a 12-year-old child after COVID-19 infection: Case report (Atena Editora)

Abstract

Idiopathic intracranial hypertension (IIH), also known as Pseudotumor cerebri, is considered a neurological disorder of unknown cause, which generates symptoms of increased intracranial pressure, despite the absence of cerebrospinal fluid cytological alteration and/or brain lesions and masses. The risk factors are divided between the prepubertal and pubertal phases, and during the second there is a difference in risk when analyzing the variables sex and weight. In the literature, there is a case report of Pediatric Multisystem Inflammatory Syndrome (MIS) and IIH, after SARS-CoV-2 infection in the pediatric population. The objective is to report a case of few similar descriptions in the literature, considering to demonstrate the relationship of the pseudotumor as a consequence of the infection by SARS-CoV-2, a recent disease in the world scenario. A retrospective analysis of the patient's chart was performed and articles from the last 5 years were searched in the database (PubMed, Cochrane and UpToDate). This is K.A.B.S., 12 years old, BMI: 32.6Kg/m², with left exotropia associated with diplopia, initially with voluntary control, starting in the last week of June 2021, evolving with gradual worsening in recent weeks. July 2021. RT PCR performed on 06/21 positive for COVID. Papilledema was evidenced after ophthalmological evaluation and referred to the emergency department of the Hospital Metropolitano Odilon Behrens (HOB). Picture exams showed no changes, lumbar puncture with opening pressure of 25.5cmH20, without signs of infection. Once the clinical diagnosis of Pseudotumor or IIH was made, it was decided to start Acetazolamide 1000mg/day, progressing with resolution of the condition. Idiopathic intracranial hypertension or pseudotumor is a disease with a low incidence and presents alarm signs and symptoms for a central nervous system disorder. Due to the lack of specific symptoms, other diagnoses must be excluded, based on laboratory and Picture tests. When analyzing the risk factors, the patient in question had two relevant characteristics: marked weight gain, with a BMI of 32.6 kg/m² and infection with COVID-19 before the onset of symptoms. As evidenced, obesity is a risk factor for the development of pseudotumor, especially during puberty. Idiopathic intracranial hypertension interferes with the patient's quality of life. Considering that there is a modifiable risk factor, changes in eating habits and physical activity must be carried out. However, for a pandemic, care must be taken with the use of masks, hand hygiene and avoid agglomerations, as COVID-19 can also be associated with neurological problems after the acute phase of the disease. Further studies on the subject are encouraged.