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BackgroundAcute ocular motility disorders (OMDs) in children admitted to Emergency Department (ED) represents a not so rare condition with a wide spectrum of different etiologies. The emergency physician must be skilled in rapidly identifying patients with potentially life threatening (LT) forms, requiring further diagnostic procedures. The aim of the study was to assess characteristics of children with acute Ocular Motility Disorders (OMDs), and to identify “red flags” for recognition of underlying life-threatening (LT) conditions.MethodsA retrospective cohort study evaluated children (2 months-17 years) admitted to a tertiary Emergency Department in 2009–2014. A subgroup analysis was performed comparing children with and without LT conditions.ResultsOf 192 visits for OMDs, the isolated strabismus occurred most frequently (55.6%), followed by pupil disorders (31.8%), ptosis (5.2%) and combined OMDs (11.5%). The majority of acute OMDs involved no underlying LT conditions (n = 136) and most of them were infants or toddlers (50%). In a multivariable analysis, LT conditions included especially children over 6 years of age, increasing the odds ratio by 2% for each months of age (p = 0.009). LT etiologies were 16 times more likely in combined OMDs (p = 0.018), were over 13 times more likely to report associated extra-ocular signs/symptoms (p = 0.017) and over 50 times more likely to report co-morbidity (p = 0.017).ConclusionOMDs are not an uncommon presentation at ED. Although most of them involve non-LT conditions, the ED physician should consider potential “red flags” for appropriate management of children such as age > 6 years, combined OMDs, extra-ocular symptoms and co-morbidity.

Pseudotumor cerebri syndrome (PTCS) is defined as a syndrome of markedly elevated intracranial pressure, with no evidence of intracranial mass, inflammation or obstruction on brain imaging. Headache, visual disturbances (e.g., diplopia, visual loss), and papilledema are the most common presenting features. The mechanism(s) underlying PTCS is still unknown. Numerous medical illnesses and medications have been associated with the risk of PTCS, and a range of renal disorders (e.g., renal transplantation, nephrotic syndrome, inherited tubulopathies, acute or chronic kidney insufficiency) can predispose to developing this raised intracranial pressure syndrome. Fluid and electrolyte balance in renal epithelial cells are regulated by a complex interaction of metabolic and/or hormonal factors. In this context, we also discuss recent studies that suggest that renal epithelial cells share many of the same features as the choroid plexus epithelial cells, which are involved in the regulation of cerebrospinal fluid dynamics.

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