Minimal diagnostic work up Specific diagnostic work up

Minimal diagnostic work up Specific diagnostic work up HISTORY Brain imaging Medication, including contraceptives? Recent rapid weight gain? Menstruational problems? Current or recent infection? Any chronic illness? Type of seizure? Exclude intracranial mass lesion, malformation, ventriculomegaly. Clinical examination Overweight? Fever? Signs of CNS-infection? Focal neurological signs (suggestive for IIH: sixth nerve palsy)? Reduced level of consciousness? High blood pressure? Exclude sinus venous thrombosis by MRV in every atypical case, poor treatment response, relapse! Lumbar puncture Performed during the morning, in lateral decubitus condition, calm child. Sedation if required. Avoid ketamine and inhalitve anaesthetics. Check CSF opening pressure: >20 cm H 2 O is abnormal Laboratory Check for: Cell count, protein, glucose. Consider infectious work-up. Na, Ca, Mg, phosphate, blood gases, BUN, glucose, AST, RBC, WBC, CRP, T 3, TSH Consider repeated LP if presentation is suggestive for IIH but pressure is within normal limits, particularly in the young child. More comprehensive work-up is required if secondary intracranial hypertension is suspected (see right column) Associated or causative Conditions IMPORTANT NOTICE: Any prepubertal child and male adolescent has to be considered atypical and secundary intracranial hypertension has to be suspected. Medical disorders: Addison’s disease; Hypoparathyroidism; Hypo- and hyperthyroidism; Vitamin D deficiency; Chronic obstructive pulmonary disease; Right heart failure with pulmonary hypertension; Sleep apnoea; Renal failure; severe iron deficiency anaemia; Thrombophilia (Antiphospholipid-Syndrome); PCOS, SLE. Medications: Tetracycline and related compounds; Nitrofuratoin; Chinolone; Vitamin A and related compounds; Anabolic steroids; Corticosteroid withdrawal following prolonged administration (including inhalative steroids); Growth hormone administration in deficient patients; Nalidixic acid, Lithium, Norplant_ levonorgestral implant system Ophthalmology Obstruction to venous drainage: Cerebral venous sinus thrombosis; Jugular vein thrombosis Use age adjusted standardised visual field testing. Use Papilledema Grading System Scale. Visus? Neuroophthalmology (VI palsy? ). (Post)infectious: Lyme-disease; postvaricella; ? ? ?