Double, Double Optic Nerve Trouble

Introduction. Idiopathic Intracranial Hypertension (IIH) is a condition most often seen in obese, adult females. IIH is rarely seen in pediatric patients, and its presentation is distinctly different from that of adults. Case Presentation. A 7-year-old African American male presented to our clinic with a complaint of diplopia for the past 5 days. Examination revealed esophoria at distance and near not noted at his previous examination and edematous optic nerve heads. Further neurological evaluation showed a normal CT and MRI with an increased opening pressure on lumbar puncture. The patient was diagnosed with IIH and started on Diamox. Deviation from Expected. IIH is very rarely seen in pediatric patients, and its presentation is unique from that of an adult patient. While adult 28 patients usually present with complaints of headache and nausea, pediatric patients are more likely to be asymptomatic or to complain of diplopia, as our patient did. Although most patients with diplopia have CN VI palsy, at the time of presentation our patient did not have any abduction deficit, only an esophoric posture on cover test. This represents a slightly atypical presentation of a very uncommon condition in the pediatric population. Conclusion. IIH is a condition that is not normally associated with pediatric patients, and its presentation and epidemiology in this population is distinctly different from that of the adult condition. It is important as clinicians to understand the difference between the presentation of IIH in adults and children.