Neuroophthalmological Symptoms in Children Treated for Internal Hydrocephalus

Tzekov, Chr.; Cherninkova, Sylvia; Gudeva, T.

doi:10.1159/000120617

Cited by 34 publications

(16 citation statements)

References 13 publications

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“…These findings are consistent with the anecdotal but extensive experience ofophthalmologists who have examined children with increased ICP over decades. [17][18][19] The RHs observed in association with raised ICP were not consistent with the severe hemorrhagic retinopathy seen in many victims of AHT (Fig 2). Even when children had severe papilledema and markedly elevated OP, the RHs were neither widespread nor numerous, were not present in the peripheral retina, and did not even extend throughout the posterior pole of the fundus.…”

Section: Discussionmentioning

confidence: 81%

Patterns of Retinal Hemorrhage Associated With Increased Intracranial Pressure in Children

Binenbaum¹,

Rogers

Forbes³

et al. 2013

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Retinal hemorrhage (RH) is an important sign of pediatric abusive head trauma. Raised intracranial pressure (ICP) is sometimes proposed as an alternate cause of RH in children being evaluated for possible child abuse.WHAT THIS STUDY ADDS: Nontraumatic, markedly elevated ICP rarely causes RH in children. When it does, RH are superficial intraretinal and located adjacent to a swollen optic nerve head. This pattern does not match the widespread pattern seen in abusive head trauma. abstract OBJECTIVE: Raised intracranial pressure (ICP) has been proposed as an isolated cause of retinal hemorrhages (RHs) in children with suspected traumatic head injury. We examined the incidence and patterns of RHs associated with increased ICP in children without trauma, measured by lumbar puncture (LP). METHODS:Children undergoing LP as part of their routine clinical care were studied prospectively at the Children' s Hospital of Philadelphia and retrospectively at Nationwide Children' s Hospital. Inclusion criteria were absence of trauma, LP opening pressure (OP) $20 cm of water (cm H 2 O), and a dilated fundus examination by an ophthalmologist or neuro-ophthalmologist. RESULTS:One hundred children were studied (mean age: 12 years; range: 3-17 years). Mean OP was 35 cm H 2 O (range: 20-56 cm H 2 O); 68 (68%) children had OP .28 cm H 2 O. The most frequent etiology was idiopathic intracranial hypertension (70%). Seventy-four children had papilledema. Sixteen children had RH: 8 had superficial intraretinal peripapillary RH adjacent to a swollen optic disc, and 8 had only splinter hemorrhages directly on a swollen disc. All had significantly elevated OP (mean: 42 cm H 2 O). CONCLUSIONS:Only a small proportion of children with nontraumatic elevated ICP have RHs. When present, RHs are associated with markedly elevated OP, intraretinal, and invariably located adjacent to a swollen optic disc. This peripapillary pattern is distinct from the multilayered, widespread pattern of RH in abusive head trauma. When RHs are numerous, multilayered, or not near a swollen optic disc (eg, elsewhere in the posterior pole or in the retinal periphery), increased ICP alone is unlikely to be the cause. Pediatrics 2013;132:e430-e434 AUTHORS:

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Section: Discussionmentioning

confidence: 81%

Patterns of Retinal Hemorrhage Associated With Increased Intracranial Pressure in Children

Binenbaum¹,

Rogers

Forbes³

et al. 2013

Pediatrics

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“…Even though papilledema has been reported as a highly specific marker for elevated intracranial pressure, the sensitivity for detecting papilledema is only 22% in those younger than 8 years of age. 22 Tuite et al hypothesized that this age-dependent sensitivity may reflect the presence of unfused sutures, 23 the fact that the subarachnoid space surrounding the optic nerve may not communicate with the subarachnoid space surrounding the brain, or the difficulty of conducting an ophthalmological exam in younger children.…”

Section: Discussionmentioning

confidence: 99%

Validation and modification of a predictive model of postresection hydrocephalus in pediatric patients with posterior fossa tumors

Foreman

McClugage

Naftel

et al. 2013

PED

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Object Postresection hydrocephalus is observed in approximately 30% of pediatric patients with posterior fossa tumors. However, which patients will develop postresection hydrocephalus is not known. The Canadian Preoperative Prediction Rule for Hydrocephalus (CPPRH) was developed in an attempt to identify this subset of patients, allowing for the optimization of their care. The authors sought to validate and critically appraise the CPPRH. Methods The authors conducted a retrospective chart review of 99 consecutive pediatric patients who presented between 2002 and 2010 with posterior fossa tumors and who subsequently underwent resection. The data were then analyzed using bivariate and multivariate analyses, and a modified CPPRH (mCPPRH) was applied. Results Seventy-six patients were evaluated. Four variables were found to be significant in predicting postresection hydrocephalus: age younger than 2 years, moderate/severe hydrocephalus, preoperative tumor diagnosis, and transependymal edema. The mCPPRH produced observed likelihood ratios of 0.737 (95% CI 0.526–1.032) and 4.688 (95% CI 1.421–15.463) for low- and high-risk groups, respectively. Conclusions The mCPPRH utilizes readily obtainable and reliable preoperative variables that together stratify children with posterior fossa tumors into high- and low-risk categories for the development of postresection hydrocephalus. This new predictive model will aid patient counseling and tailor the intensity of postoperative clinical and radiographic monitoring for hydrocephalus, as well as provide evidence-based guidance for the use of prophylactic CSF diversion.

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“…It is a condition in which there is an accumulation of cerebrospinal fluid (CSF). The clinical features of hydrocephalus, especially in the first months of life, is the increase in cranial volume detected by frequent measurements of head circumference, together with the help of appropriate curves and by imaging studies [1].…”

Section: Introductionmentioning

confidence: 99%

Visual acuity evaluation in children with hydrocephalus: An electrophysiological study with sweep visual evoked potential

Pereira¹,

Costa²

2012

WJNS

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The objective was to measure the visual acuity (VA) of children with the diagnosis of hydrocephalus with or without peritoneal-ventricular shunt (PVS). A total of 55 children were included in the study (34 Female), with an age range of 0 to 291 weeks. The VA was measured by the sweep visual evoked potential technique. Of those with a PVS, in 31 the ventricular valve was inserted before 15 days after the diagnosis whereas in 14 the ventricular valve was inserted after 15 days. The sweep VEP was performed in all children, 95 exams (94%) were abnormal and only 6 were normal. There was a statistical difference in the VA between children with a PVS inserted before 15 days of the diagnosis and children with a PVS after 15 days (p = 0.038) or those without a shunt (p = 0.031). Children with no complications of the PVS had a better VA as compared to those with shunt complications (p < 0.001). In the group of children with complications, again those who had a shunt inserted before 15 days had better VA results in comparison to those in whom the shunt was inserted after 15 days (p = 0.029). No statistical difference in the VA was found between children without the PVS and with those in which the shunt was inserted after 15 days of the diagnosis of hydrocephalus (p = 0.699). We conclude that the delayed insertion of the PVS may compromise the visual development of these children.

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Neuroophthalmological Symptoms in Children Treated for Internal Hydrocephalus

Cited by 34 publications

References 13 publications

Patterns of Retinal Hemorrhage Associated With Increased Intracranial Pressure in Children

Patterns of Retinal Hemorrhage Associated With Increased Intracranial Pressure in Children

Validation and modification of a predictive model of postresection hydrocephalus in pediatric patients with posterior fossa tumors

Visual acuity evaluation in children with hydrocephalus: An electrophysiological study with sweep visual evoked potential

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