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While idiopathic intracranial hypertension (IIH) is more commonly recognized as a disorder of adults, it affects children of all ages and can have distinctive characteristics when presenting in the prepubertal age group. It is characterized by raised intracranial pressure (ICP) in the absence of brain parenchymal lesion, vascular malformations, hydrocephalus, or central nervous system (CNS) infection. The diagnosis is usually confirmed by a high opening pressure of cerebrospinal fluid (CSF) with exclusion of secondary causes of intracranial hypertension. Objectives: The purpose of this review is to summarize relevant articles on the diagnostic tools used in evaluation and management of pediatric IIH. A summary of demographics, clinical presentation, diagnosis, neuroimaging, as well as existing evidence of treatment strategies is presented. Method: We conducted a bibliographic search in PubMed using the terms idiopathic intracranial hypertension (IIH), Pseudotumor Cerebri syndrome (PTCS). The review of the literature revealed a lack of published consistent data on the diagnosis criteria and management of idiopathic intracranial hypertension in children.
Conclusion:This article provides a review of IIH in children and revised diagnostic criteria based on recent evidence and published opinion. Relative to the adult population, the demographic features and clinical presentation of IIH as well as the diagnosis and treatment guidelines for children are quite different. This review highlights the importance of early recognition and management of IIH to prevent permanent visual loss. Key words: idiopathic intracranial hypertension, pseudotumor cerebri syndrome Idiopathic intracranial hypertension (IIH), also referred to as Pseudotumor Cerebri, is characterized by elevated intracranial pressure without discernable etiology, with normal cerebrospinal fluid content, and normal contrast-enhanced computed tomography (CT) or magnetic resonance irradiation (1,2,3).
Despite being closely monitored for their current and more acute pathology, cancer screening and in particular urological cancer screening is often neglected in patients with end stage renal disease undergoing dialysis. This review encompasses the diagnosis of urological malignancies that occur in end-stage renal patients after the initiation of hemodialysis. We conducted a literature search in PubMed and UpToDate databases using the diagnostic criteria for urological malignancies in hemodialysis patients. Based on the existing data in the current literature it seems that patients undergoing dialysis have a higher risk of developing cancer than the general population, with peculiarities in both cancer detection and investigation that need to be addressed. Further studies should be made in order to improve cancer screening and diagnosis in dialysis patients.
Adult patients who present with papilloedema and symptoms of raised intracranial pressure need urgent multidisciplinary assessment including neuroimaging, to exclude life-threatening causes. Where there is no apparent underlying cause for the raised intracranial pressure, patients are considered to have idiopathic intracranial hypertension (IIH). Objectives: This review encompasses the newly revised diagnostic criteria for PTCS in adults and children and the role of obesity in the epidemiology, etiology, and management of IIH.Furthermore, this paper tries to offer a practical approach to assessing patients with papilloedema, the investigations and the subsequent management of patients with IIH. Methodology: PubMed was used to search for IIH and Pseudotumor Cerebri. The vast majority of the literature consisted of cohort studies, case control studies, systematic reviews and other narrative reviews. Conclusion: Idiopathic intracranial hypertension (IIH), also known as primary Pseudotumor Cerebri syndrome (PTCS), is a condition of unknown etiology which affects primarily overweight, reproductive-aged women and causes increased intracranial pressure (ICP). This review discusses the recently revised diagnostic criteria for IIH for adults and children and the controversial issues in its diagnosis and management.
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