Secondary headache and raised intracranial pressure — structured clinical encounter

Task 1 — Recognise the red-flag pattern and form a problem representation (3 minutes)

From the history and the examination, identify the features that mark this as a secondary headache rather than a primary one, and explain why papilloedema is the pivot of the assessment. State your problem representation in one sentence, and explain the significance of the minocycline and the obesity for the differential diagnosis. [8] [3]

Task 2 — Reproduce the diagnostic criteria and plan the work-up (4 minutes)

State the Friedman 2013 revised diagnostic criteria for the pseudotumour cerebri syndrome, naming the specific imaging required to exclude a secondary cause and the role of the lumbar puncture. Explain why the lumbar puncture is performed only after imaging, and describe the cerebrospinal-fluid opening-pressure threshold and its interpretation in a child, including the caveat around the paediatric value. [5] [6]

Task 3 — Separate idiopathic from secondary intracranial hypertension (3 minutes)

The magnetic resonance imaging with venography is normal and the lumbar puncture opening pressure is 330 millimetres with normal cerebrospinal-fluid composition. Explain how you decide whether this is idiopathic or secondary intracranial hypertension in light of the minocycline, and state the first management step that applies in either case. [5] [7]

Task 4 — The management plan and the conversation about vision (5 minutes)

Outline the stepwise definitive management, including the weight advice, the acetazolamide and its dose, the monitoring of serum bicarbonate and potassium, and the surgical options for threatened vision. Explain why vision is the governing outcome and describe the serial surveillance that defines the follow-up. Finally, outline the conversation you would have with the girl and her mother about prognosis, adherence, and the circumstance that would make this a neuro-ophthalmological emergency. [7] [9] [8]