Assessment of Pediatric Pseudotumor Cerebri Clinical Characteristics and Outcomes

Yamamoto, Erin; Farber, Darren; Rothner, David; Moodley, Manikum

doi:10.1177/0883073820972231

Cited by 14 publications

(25 citation statements)

References 39 publications

(56 reference statements)

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“…Although to a lesser degree, Yamamoto et al also found that 22 patients (13.3%) in their study did not present with symptoms such as headache but were found to have papilledema on examination. 7 Furthermore, our study found asymptomatic females and children older than 12 years had a higher risk of positive findings on neuroimaging when compared to males and children under 12 years. This may suggest a lower threshold for neuroimaging should be emphasized in patients in certain demographic groups despite the lack of symptoms.…”

Section: Discussionmentioning

confidence: 49%

“…When symptoms were reported, headache was most commonly reported followed by visual disturbances, consistent with prior studies. 4 , 5 , 7 However, 56 children in our study were asymptomatic at presentation. Despite the lack of symptoms, 41% of asymptomatic patients were diagnosed with papilledema.…”

Section: Discussionmentioning

confidence: 63%

“…These data align with prior studies that found that most patients with papilledema were females in early adolescence. 4 , 7 However the sex and age trends were similar in children with both papilledema and pseudopapilledema, highlighting that age and sex alone cannot distinguish between these diagnoses.…”

Section: Discussionmentioning

confidence: 95%

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Trends and Clinical Characteristics of Pediatric Patients Presenting to an Ophthalmology Emergency Department with an Initial Diagnosis of Optic Nerve Head Elevation

Cavuoto¹,

Markatia²,

Patel³

et al. 2022

OPTH

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Objective Optic nerve head elevation may be the only clinical sign of a vision- and/or life-threatening condition, particularly in children who are asymptomatic or fail to report symptoms. The purpose of this study is to identify epidemiologic trends, clinical characteristics, and diagnostic outcomes of pediatric patients presenting to an ophthalmology emergency department (ED) with suspected optic nerve head elevation. Methods This retrospective study identified pediatric patients (≤18 years) presenting to an ophthalmology ED over a five- year period with suspected optic nerve head elevation to describe demographic trends, clinical characteristics, and diagnostic outcomes. Results Of the 213 patients, the majority were female (73.2%) and tended to be older than males (14.3 vs 11.2 years, p<0.001). The most common diagnoses were papilledema (52.6%), pseudopapilledema (31.5%), and optic nerve drusen (8.0%). When symptoms were present, most (73.7%) patients presented with headache (67.5%) or visual disturbance (54.8%). Of 144 neuroimaging studies obtained, 80 (55.6%) had positive findings and these were significantly associated with symptoms at presentation (p=0.017) and age (p=0.034), but not sex (p=0.791). Asymptomatic females and children >12 years old were more likely to have an abnormal MRI than males and children ≤ 12 (OR=1.56 and 1.22, respectively). Conclusion Patient demographics such as age and sex in conjunction with concurrent symptoms are important factors in determining the urgency of neuroimaging in children with suspected optic nerve head elevation.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 63%

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Trends and Clinical Characteristics of Pediatric Patients Presenting to an Ophthalmology Emergency Department with an Initial Diagnosis of Optic Nerve Head Elevation

Cavuoto¹,

Markatia²,

Patel³

et al. 2022

OPTH

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“…In our case, the neurosurgeon described the opening pressure as increased on both occasions by counting the number of CSF drops flowing through the spinal needle in a specified period, as already described [ 6 , 7 ], however we do not know the precise pressure measurement. In published studies on PTCS, CSF opening pressure was not documented for all the patients, because other factors documented indirectly elevated CSF pressure (symptoms, imaging data) [ 8 , 19 ]. Our infant presented with papilloedema and bulging anterior fontanel, which represent indirect signs of high CSF pressure.…”

Section: Discussionmentioning

confidence: 99%

Infantile idiopathic intracranial hypertension: case report and review of the literature

et al. 2022

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Background Idiopathic intracranial hypertension is an infrequent condition of childhood, and is extremely rare in infants, with only 26 cases described. The etiology is still unknown. Typical clinical manifestations change with age, and symptoms are atypical in infants, thus the diagnosis could be late. This is based on increased opening pressure at lumbar puncture, papilloedema and normal cerebral MRI. The measurement of cerebrospinal fluid opening pressure in infants is an issue because many factors may affect it, and data about normal values are scanty. The mainstay of treatment is acetazolamide, which allows to relieve symptoms and to avoid permanent visual loss if promptly administered. Case presentation We report the case of an 8-month-old infant admitted because of vomit, loss of appetite and irritability; later, also bulging anterior fontanel was observed. Cerebral MRI and cerebrospinal fluid analysis resulted negative and after two lumbar punctures he experienced initial symptom relief. Once the diagnosis of idiopathic intracranial hypertension was made, he received oral acetazolamide, and corticosteroids, with progressive symptom resolution. Conclusions Infantile idiopathic intracranial hypertension is extremely rare, and not well described yet. Bulging anterior fontanel in otherwise healthy infants with normal neuroimaging should be always considered suggestive, but can be a late sign, while irritability and anorexia, especially if associated with vomiting, may represent an early sign. In such cases, lumbar puncture should be always done, hopefully with cerebrospinal fluid opening pressure measurement, which is among coded diagnostic criteria, but whose threshold is controversial in infants. Early diagnosis, timely treatment and strict follow-up help to prevent vision loss or death of affected infants.

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“…IIH is a syndrome of increased intracranial pressure with normal cerebrospinal fluid composition, normal neuroanatomy, absence of space-occupying mass, and a normal neurological examination [4]. The term PTCS has been used to incorporate both primary and secondary causes as the term IIH cannot be used for patients having clinical features with an identifiable etiology [5].…”

Section: Discussionmentioning

confidence: 99%

Neurological manifestation of Vitamin D deficiency

Sroa¹,

Nair²,

Najmuddin³

et al. 2021

Indian J Case Reports

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Idiopathic intracranial hypertension, also known as pseudotumor cerebri, is a disorder with raised intracranial pressure, headache, papilledema, visual disturbances with a normal cerebrospinal fluid examination, and normal neuroimaging. It is rare in the pediatric population and may occur as a manifestation of underlying disorders. Vitamin D deficiency is a common deficiency in the pediatric age group. However, neurological manifestations are rare. Here, we present the case of a 5-year-old male child who presented with headache, vomiting, and hypertension; however, the neurological examination was normal but the neuroimaging was suggestive of pseudotumor cerebri. Appropriate investigations were done. The most likely cause of pseudotumor cerebri in this patient was the deficiency of Vitamin D. We have reported this case as pseudotumor cerebri is a rare neurological manifestation of Vitamin D deficiency.

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Assessment of Pediatric Pseudotumor Cerebri Clinical Characteristics and Outcomes

Cited by 14 publications

References 39 publications

Trends and Clinical Characteristics of Pediatric Patients Presenting to an Ophthalmology Emergency Department with an Initial Diagnosis of Optic Nerve Head Elevation

Trends and Clinical Characteristics of Pediatric Patients Presenting to an Ophthalmology Emergency Department with an Initial Diagnosis of Optic Nerve Head Elevation

Infantile idiopathic intracranial hypertension: case report and review of the literature

Neurological manifestation of Vitamin D deficiency

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