Multisystem Inflammatory Syndrome in Children Presenting With Pseudotumor Cerebri and a Review of the Literature

Bilen, Nimet Melis; Bal, Zümrüt Şahbudak; Arslan, Sema; Kanmaz, Seda; Kurugöl, Zafer; Özkınay, Ferda

doi:10.1097/inf.0000000000003327

Cited by 6 publications

(11 citation statements)

References 21 publications

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“…After treatment, optic disc oedema resolved. Bilen et al also reported a case of bilateral papilledema with low vision [10]. Baccarella et al reported two cases with increased intracranial pressure and papilledema [11].…”

Section: Discussionmentioning

confidence: 97%

“…In the literature, the most frequently reported ocular finding in the acute phase in patients undergoing MIS-C is conjunctivitis, similar to Kawasaki disease, and less commonly punctuate epitheliopathy, anterior uveitis and papilledema [7][8][9][10][11][12]. Studies in the literature generally include the findings of MIS-C in the acute period.…”

Section: Introductionmentioning

confidence: 99%

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A prospective long-term evaluation of the ocular findings of children followed with the diagnosis of multisystem inflammatory syndrome (long-term evaluation of ocular findings following MIS-C)

Kaya-Guner

Şahin

Keleş

et al. 2023

Eye

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BACKGROUND/OBJECTIVES: The most frequently reported ocular finding in the acute phase of the multisystem inflammatory syndrome in children (MIS-C), is conjunctivitis. More rarely, punctuate epitheliopathy, anterior uveitis and optic disc oedema can be seen. We aimed to investigate the acute and long-term ocular effects of MIS-C. SUBJECTS/METHODS: Cases aged 1 month to 18 years who were diagnosed with MIS-C between January 2022 and June 2022 in the Department of Pediatric Infectious Diseases in our hospital were included in the study. Ophthalmological examinations were performed immediately after diagnosis, at one month, three months, and six months. RESULTS: Males consisted of 64.7% of the 34 cases included in the study and the mean age was 8.68 ± 4.32 years (min-max:2-17). In the first examination, conjunctivitis was observed in 6 (17.6%), punctuate epitheliopathy in 4 (11.7%), and subconjunctival haemorrhage in 3 (8.8%) patients. Two patients (5.8%) had optic disc oedema. No pathological anterior or posterior segment findings were observed in the sixth-month examination. The relationship between subconjunctival haemorrhage and intensive care hospitalisation was statistically significant (p = 0.014). Also, all patients with subconjunctival haemorrhage were clinically classified as severe MIS-C (p = 0.002). CONCLUSION: Although pathological ocular findings were observed in the acute phase of the disease, all of them were found to be improved at the sixth-month follow-up. The most striking finding of our study is that cases with subconjunctival haemorrhage were clinically more severe, and all patients needed intensive care. This study may be informative in establishing ocular follow-up protocols that are expected to be carried out in the acute period and in the follow-up of these patients.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

A prospective long-term evaluation of the ocular findings of children followed with the diagnosis of multisystem inflammatory syndrome (long-term evaluation of ocular findings following MIS-C)

Kaya-Guner

Şahin

Keleş

et al. 2023

Eye

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“…Other inflammatory diseases have also been associated with pseudotumor cerebri. 20,21 The contribution of inflammatory mechanisms and changes in cytokine levels have been proposed as one of the pathophysiological mechanisms of this disorder. One study found that one-third of IIH patients showed various patterns of oligoclonal bands (OCBs).…”

Section: Inflammatory Markersmentioning

confidence: 99%

Cerebrospinal fluid (CSF) and idiopatic intracranial hypertension (IIH): a critical review

Domingues

Vega²,

Brunale³

et al. 2022

Headache Med

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Pseudotumor cerebri is a syndrome that results from increased intracranial pressure. The main symptoms are headache, vision disturbances, and pulsatile tinnitus. Definitive diagnosis requires the presence of clinical and/or radiological signs of intracranial hypertension, high opening pressure on lumbar puncture (LP), and normal CSF constitution. Several studies have evaluated new contributions of CSF in the clinical evaluation and the in understanding of the pathophysiology of pseudotumor cerebri. Such studies have included the analysis of inflammatory biomarkers, adipokines, proteomic analysis, and CSF flow studies. In this review, we present the main results obtained so far and critically discuss the present status and the potential role of research involving the CSF in this condition. Based on current knowledge, it is possible to conclude that CSF research with new biomarkers has not yet provided information that can be employed in clinical practice at this moment. However, a better understanding of the constitution and dynamics of CSF circulation in patients with pseudotumor cerebri has brought some information about this condition and can potentially improve our knowledge about this condition in the future.

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“…Globally multisystem inflammatory syndrome in children (MIS-C) is a life-threatening inflammatory response ( 3 ) resulting from COVID-19 ( 4 – 6 ). It is caused by an abnormal immune response to the SARS-CoV-2 virus ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Case report: Managing multisystem inflammatory syndrome in children (MIS-C) in Lao People's Democratic Republic, a success story

Douangboupha

Nhiacha²,

Sodaluck³

et al. 2023

Front. Pediatr.

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IntroductionMultisystem inflammatory syndrome in children (MIS-C) is believed to be one of the most important life-threatening complications of COVID-19 infection among children. In any setting, early recognition, investigations, and management of MIS-C is crucial, but it is particularly difficult in resource-limited settings (RLS). This is the first case report of MIS-C in Lao People's Democratic Republic (Lao PDR) that was promptly recognized, treated, and resulted in full recovery with no known complications despite the resource limitations.Case presentationA healthy 9-year-old boy presented to a central teaching hospital fulfilling the World Health's Organization's MIS-C criteria. The patient had never received a COVID-19 vaccine and had a history of COVID-19 contact. The diagnosis was based upon the history, changes in the patient's clinical status, and response to treatment and negative testing and response to treatment for alternative diagnoses. Despite management challenges relating to limited access to an intensive care bed and the high cost of IVIG; the patient received a full course of treatment and appropriate follow-up cares post discharge. There were several aspects to this case that may not hold true for other children in Lao PDR. First, the family lived in the capital city, close to the central hospitals. Second, the family was able to afford repeated visits to private clinics, and the cost of IVIG, and other treatments. Third, the physicians involved in his care promptly recognized a new diagnosis.ConclusionsMIS-C is a rare but life-threatening complication of COVID-19 infection among children. The management of MIS-C requires early recognition, investigations, and interventions which may be difficult to access, cost-prohibitive, and further increase demand on healthcare services that are already limited in RLS. Nevertheless, clinicians must consider means for improving access, determine which tests and interventions are worth the cost, and establishing local clinical guidelines for working within resource constraints while awaiting additional assistance from local and international public health systems. Additionally, using COVID-19 vaccination to prevent MIS-C and its complication for children may be cost-effective.

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Multisystem Inflammatory Syndrome in Children Presenting With Pseudotumor Cerebri and a Review of the Literature

Cited by 6 publications

References 21 publications

A prospective long-term evaluation of the ocular findings of children followed with the diagnosis of multisystem inflammatory syndrome (long-term evaluation of ocular findings following MIS-C)

A prospective long-term evaluation of the ocular findings of children followed with the diagnosis of multisystem inflammatory syndrome (long-term evaluation of ocular findings following MIS-C)

Cerebrospinal fluid (CSF) and idiopatic intracranial hypertension (IIH): a critical review

Case report: Managing multisystem inflammatory syndrome in children (MIS-C) in Lao People's Democratic Republic, a success story

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