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Nguyen L, Miles DK, Harder L, Singh S, Whittemore BA, Greenberg BM, Wang CX. Increased Intracranial Pressure in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200174. [PMID: 37918972 PMCID: PMC10621892 DOI: 10.1212/nxi.0000000000200174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/28/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Elevated intracranial pressure (ICP) in myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) has been largely unexplored. The objectives of this study were to determine the frequency of increased ICP in MOGAD and its association with disease course and outcomes and to highlight cases requiring medical and/or surgical management of increased ICP. METHODS In this retrospective, single-center cohort study, we examined the clinical and paraclinical data from the initial presentation and follow-up data of children diagnosed with MOGAD. In those with opening pressure (OP) measurements, univariate analyses were used to evaluate factors associated with increased ICP, which was defined as OP > 28 cm H2O. We also present a case series of patients with or without OP measurement who required medical and/or surgical management of increased ICP. RESULTS Of 86 children with MOGAD, 43 (50.0%) had an OP recorded and 7 (8.1%) required ICP management. In those with OP recorded, the median (interquartile range) OP for the different MOGAD phenotypes were: 30.0 (22.8-41.6) (acute disseminated encephalomyelitis, ADEM), 20.5 (16.1-23.6) (optic neuritis), 17.0 (17.0-22.5) (myelitis), and 19.5 (16.5-29.3) (other) cm H20. Overall, 20.9% had increased ICP based on an OP > 28 cm H2O, of whom 77.8% presented with ADEM. In a subgroup analysis of those presenting with ADEM, those with an elevated ICP had longer hospital stay (p = 0.007) and neurologic disability (defined as modified Rankin Scale >1) (p = 0.049). In those with or without OP recorded, 7 (6 with ADEM, one with cerebral cortical encephalitis) required ICP-directed therapies. Findings on brain MRI in these 7 children revealed extensive disease burden with bilateral cerebral involvement and evidence of restricted diffusion. While neuropsychological data in this small subset revealed significant variability, all sustained identifiable deficits after discharge, including attention-deficit hyperactivity disorders and language and learning disorders. DISCUSSION In pediatric MOGAD, increased OP and ADEM at initial presentation were associated with longer hospital stays and greater long-term morbidity. Although invasive ICP monitoring has not been specifically advocated in the management of MOGAD, it is important to recognize signs and symptoms of increased ICP in these patients and consider ICP monitoring and management strategies based on clinical and radiologic findings, especially in those presenting with ADEM and with OP > 28 cm H2O.
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Affiliation(s)
- Linda Nguyen
- From the Department of Neurology (L.N., L.H., B.M.G., C.X.W.); Department of Pediatrics (D.K.M., B.M.G., C.X.W.); Department of Psychiatry (L.H.); Department of Radiology (S.S.); and Department of Neurological Surgery (B.A.W.), University of Texas Southwestern Medical Center, Dallas.
| | - Darryl K Miles
- From the Department of Neurology (L.N., L.H., B.M.G., C.X.W.); Department of Pediatrics (D.K.M., B.M.G., C.X.W.); Department of Psychiatry (L.H.); Department of Radiology (S.S.); and Department of Neurological Surgery (B.A.W.), University of Texas Southwestern Medical Center, Dallas
| | - Lana Harder
- From the Department of Neurology (L.N., L.H., B.M.G., C.X.W.); Department of Pediatrics (D.K.M., B.M.G., C.X.W.); Department of Psychiatry (L.H.); Department of Radiology (S.S.); and Department of Neurological Surgery (B.A.W.), University of Texas Southwestern Medical Center, Dallas
| | - Sumit Singh
- From the Department of Neurology (L.N., L.H., B.M.G., C.X.W.); Department of Pediatrics (D.K.M., B.M.G., C.X.W.); Department of Psychiatry (L.H.); Department of Radiology (S.S.); and Department of Neurological Surgery (B.A.W.), University of Texas Southwestern Medical Center, Dallas
| | - Brett A Whittemore
- From the Department of Neurology (L.N., L.H., B.M.G., C.X.W.); Department of Pediatrics (D.K.M., B.M.G., C.X.W.); Department of Psychiatry (L.H.); Department of Radiology (S.S.); and Department of Neurological Surgery (B.A.W.), University of Texas Southwestern Medical Center, Dallas
| | - Benjamin M Greenberg
- From the Department of Neurology (L.N., L.H., B.M.G., C.X.W.); Department of Pediatrics (D.K.M., B.M.G., C.X.W.); Department of Psychiatry (L.H.); Department of Radiology (S.S.); and Department of Neurological Surgery (B.A.W.), University of Texas Southwestern Medical Center, Dallas
| | - Cynthia X Wang
- From the Department of Neurology (L.N., L.H., B.M.G., C.X.W.); Department of Pediatrics (D.K.M., B.M.G., C.X.W.); Department of Psychiatry (L.H.); Department of Radiology (S.S.); and Department of Neurological Surgery (B.A.W.), University of Texas Southwestern Medical Center, Dallas
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Zhou DJ, Powers AM, Cave CA, Dickas EK, Rickard MC, Rathore G, Wright RR, Zabad RK, Koh S. Perplexing Initial Presentations of MOGAD in Two Children: Intracranial Hypertension and New-Onset Seizure. Neurohospitalist 2023; 13:438-444. [PMID: 37701249 PMCID: PMC10494829 DOI: 10.1177/19418744231192159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
We report two distinct challenging initial presentations of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Case 1 describes a 12-year-old boy who developed headaches refractory to pain medication followed by cranial neuropathies and intracranial hypertension, confirmed by lumbar puncture with an opening pressure >36 cm H2O. Case 2 describes a 3-year-old boy who developed new-onset seizures refractory to antiseizure medications, a presentation of FLAIR-hyperintense lesions in MOG-antibody associated encephalitis with seizures (FLAMES). On repeat magnetic resonance imaging, both patients were found to have cortical T2 hyperintensities, leptomeningeal contrast enhancement, and bilateral optic nerve enhancement. In the cerebrospinal fluid, both patients had CSF pleocytosis with neutrophilic predominance. The patients were treated with intravenous immunoglobulins, plasma exchange, and high-dose corticosteroids. The first patient achieved disease remission, whereas the second patient required the addition of rituximab for management of seizures. The two cases highlight the pleomorphic clinical phenotypes of MOGAD.
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Affiliation(s)
- Daniel J. Zhou
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Andria M. Powers
- Department of Radiology, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Caleb A. Cave
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Emily K. Dickas
- Division of Neurology, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Mary C. Rickard
- Division of Neurology, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Geetanjali Rathore
- Division of Neurology, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Rhonda R. Wright
- Division of Neurology, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Rana K. Zabad
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sookyong Koh
- Division of Neurology, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
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Kornbluh AB, Kahn I. Pediatric Multiple Sclerosis. Semin Pediatr Neurol 2023; 46:101054. [PMID: 37451754 DOI: 10.1016/j.spen.2023.101054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/07/2023] [Accepted: 05/07/2023] [Indexed: 07/18/2023]
Abstract
The current diagnostic criteria for pediatric onset multiple sclerosis (POMS) are summarized, as well as the evidence for performance of the most recent iteration of McDonald criteria in the pediatric population. Next, the varied roles of MRI in POMS are reviewed, including diagnostic considerations and research-based utilization. The primary role of bloodwork and cerebrospinal fluid studies in the diagnosis of POMS is to rule out disease mimics. Prognostically, POMS portends a more inflammatory course with higher relapse rate and disability reached at younger ages compared with AOMS counterparts. As such, there is an emerging trend toward the earlier use of highly efficacious disease modifying therapies to target prompt immunomodulatory disease control. Current POMS disease modifying therapies (DMTs) and active clinical POMS trials are detailed.
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Affiliation(s)
- Alexandra B Kornbluh
- Children's National Hospital, Washington, DC; George Washington School of Medicine and Health Sciences, Washington, DC
| | - Ilana Kahn
- Children's National Hospital, Washington, DC; George Washington School of Medicine and Health Sciences, Washington, DC.
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Maran JJ, Sharpe C, Carroll S. Paediatric MOG-antibody disease presenting with intracranial hypertension and unilateral vision loss without radiological evidence of optic neuritis. J Neuroimmunol 2023; 378:578083. [PMID: 37058851 DOI: 10.1016/j.jneuroim.2023.578083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/16/2023] [Accepted: 04/01/2023] [Indexed: 04/16/2023]
Abstract
Intracranial hypertension (IH) is poorly described in paediatric myelin oligodendrocyte glycoprotein antibody disease (MOGAD). We describe a unique case of seropositive MOGAD in an obese 13-year-old boy who presented with an isolated IH, bilateral optic disc swelling and sudden-onset complete vision loss in one eye without radiological evidence of optic nerve involvement. Treatment with intravenous methylprednisolone combined with an emergency shunt fully restored vision and resolved the optic disc swelling. This report adds to the growing body of evidence suggesting that obese children presenting with isolated IH should be investigated for MOGAD, and the importance of managing IH during MOGAD.
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Affiliation(s)
- Jack Jonathan Maran
- Buchanan Ocular Therapeutics Unit, Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, New Zealand; Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
| | - Cynthia Sharpe
- Faculty of Medical and Health Sciences, University of Auckland, New Zealand; Deparment of Paediatric Neurology, Starship Children's Health, Te Whatu Ora, Health New Zealand, Auckland, New Zealand
| | - Stuart Carroll
- Department of Ophthalmology, Greenlane Clinical Centre, Te Whatu Ora, Health New Zealand, Auckland, New Zealand
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Alqahtani Y, Oshi M, Kamal NM, Aljabri M, Abosabie S, Elhaj W, Abosabie SA. Pediatric myelin oligodendrocyte glycoprotein antibody associated disease-Asymmetric papilledema and elevated ICP are two of the chameleons: A case report. Medicine (Baltimore) 2023; 102:e32986. [PMID: 36827019 DOI: 10.1097/md.0000000000032986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody (MOGA) associated diseases are inflammatory immune-mediated demyelinating disorders with relapse potential involving the central nervous system. Multiple unusual clinical manifestations of those disorders were reported, making treatment decisions difficult. CASE PRESENTATION A healthy 12-year-old obese boy presented with headache and bilateral asymmetric papilledema. The patient had a negative medical history. His neurological and general examinations were unremarkable, his initial magnetic resonance imaging showed elevated intracranial pressure (ICP) only. A lumbar puncture revealed increased opening pressure and pleocytosis. The MOGA titer was 1:320. He needed acetazolamide and steroid therapy. After 2 months of medication, weight loss, exercise, the patient symptoms significantly improved, papilledema resolved, and visual function improved. CONCLUSION MOGA-associated disorders have a variety of clinical features, so a high index of suspicion is required for their diagnosis. Papilledema and an elevated ICP are 2 of the chameleons of MOGA-associated disorders. MOGA test may be useful in patients with elevated ICP and inflammatory cerebrospinal fluid profiles. An investigation of the possible association between those disorders and high ICP is warranted.
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Affiliation(s)
- Youssef Alqahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mohammed Oshi
- Department of Pediatrics, Neurology Division, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Naglaa M Kamal
- Pediatrics and Pediatric Hepatology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohammed Aljabri
- Department of Pediatrics, Neurology Division, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Salma Abosabie
- Faculty of Medicine, Julius-Maximilians-Universität Würzburg, Bavaria, Germany
| | - Waleed Elhaj
- Department of Pediatrics, Neurology Division, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Sara A Abosabie
- Faculty of Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
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6
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Miller MJ, Hicks MJ, Foroozan R, Brodsky MC. A high-pressure situation. Surv Ophthalmol 2022:S0039-6257(22)00112-6. [PMID: 35970231 DOI: 10.1016/j.survophthal.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
An 8-year-old boy presented with acute visual loss in the right eye and nausea, vomiting, and diplopia. Imaging revealed a right orbital apex mass. Biopsy showed Langerhans cell histiocytosis (LCH), and the patient was diagnosed with isolated orbital LCH causing an orbital apex syndrome. A 12-month cytarabine chemotherapy course was begun, during which the patient developed bilateral optic disc edema. He was diagnosed with cytarabine-induced intracranial hypertension, which was successfully treated with acetazolamide. The cytarabine course was completed with complete resolution of the LCH lesion. The ophthalmologic relevance of this rare disorder is discussed.
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Affiliation(s)
| | - M John Hicks
- Baylor College of Medicine, Houston, Texas, USA; Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas, USA; Department of Pathology, Texas Children's Hospital, Houston, Texas, USA
| | - Rod Foroozan
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA.
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Nikolaos G, Despoina T, Paraskevi P, Athanasios E. Increased ICP as the first sign of pediatric-onset multiple sclerosis: A case report and brief review of the literature. Ann Indian Acad Neurol 2022; 25:567-569. [PMID: 35936575 PMCID: PMC9350794 DOI: 10.4103/aian.aian_877_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/13/2022] [Accepted: 01/22/2022] [Indexed: 11/30/2022] Open
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8
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The Incidence of Transverse Sinus Stenosis in Multiple Sclerosis: Further Evidence of Pulse Wave Encephalopathy. Mult Scler Relat Disord 2020; 46:102524. [DOI: 10.1016/j.msard.2020.102524] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 02/07/2023]
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9
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Petzold A, Coric D, Balk LJ, Hamann S, Uitdehaag BMJ, Denniston AK, Keane PA, Crabb DP. Longitudinal Development of Peripapillary Hyper-Reflective Ovoid Masslike Structures Suggests a Novel Pathological Pathway in Multiple Sclerosis. Ann Neurol 2020; 88:309-319. [PMID: 32426856 PMCID: PMC7496959 DOI: 10.1002/ana.25782] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Peripapillary hyper-reflective ovoid masslike structures (PHOMS) are a new spectral domain optical coherence tomography (OCT) finding. METHODS This prospective, longitudinal study included patients (n = 212) with multiple sclerosis (MS; n = 418 eyes), 59 healthy controls (HCs; n = 117 eyes), and 267 non-MS disease controls (534 eyes). OCT and diffusion tensor imaging were used. RESULTS There were no PHOMS in HC eyes (0/117, 0%). The prevalence of PHOMS was significantly higher in patients with MS (34/212, p = 0.001) and MS eyes (45/418, p = 0.0002) when compared to HCs (0/59, 0/117). The inter-rater agreement for PHOMS was 97.9% (kappa = 0.951). PHOMS were present in 16% of patients with relapsing-remitting, 16% of patients with progressive, and 12% of patients with secondary progressive disease course (2% of eyes). There was no relationship of PHOMS with age, disease duration, disease course, disability, or disease-modifying treatments. The fractional anisotropy of the optic radiations was lower in patients without PHOMS (0.814) when compared to patients with PHOMS (0.845, p = 0.03). The majority of PHOMS remained stable, but increase in size and de novo development of PHOMS were also observed. In non-MS disease controls, PHOMS were observed in intracranial hypertension (62%), optic disc drusen (47%), anomalous optic discs (44%), isolated optic neuritis (19%), and optic atrophy (12%). INTERPRETATION These data suggest that PHOMS are a novel finding in MS pathology. Future research is needed to determine whether development of PHOMS in MS is due to intermittently raised intracranial pressure or an otherwise impaired "glymphatic" outflow from eye to brain. ANN NEUROL 2020;88:309-319.
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Affiliation(s)
- Axel Petzold
- Dutch Expertise Center for Neuro‐Ophthalmology and Multiple Sclerosis Center, Departments of Neurology and OphthalmologyAmsterdam University Medical CenterAmsterdamThe Netherlands
- Moorfields Eye Hospital and National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
- University College London Queen Square Institute of NeurologyLondonUnited Kingdom
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of OphthalmologyLondonUnited Kingdom
| | - Danko Coric
- Dutch Expertise Center for Neuro‐Ophthalmology and Multiple Sclerosis Center, Departments of Neurology and OphthalmologyAmsterdam University Medical CenterAmsterdamThe Netherlands
- Multiple Sclerosis Center and Department of NeurologyAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Lisanne J. Balk
- Dutch Expertise Center for Neuro‐Ophthalmology and Multiple Sclerosis Center, Departments of Neurology and OphthalmologyAmsterdam University Medical CenterAmsterdamThe Netherlands
- Multiple Sclerosis Center and Department of NeurologyAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Steffen Hamann
- Department of Ophthalmology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - Bernard M. J. Uitdehaag
- Multiple Sclerosis Center and Department of NeurologyAmsterdam University Medical CenterAmsterdamThe Netherlands
| | - Alastair K. Denniston
- National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of OphthalmologyLondonUnited Kingdom
- Department of OphthalmologyUniversity Hospitals Birmingham National Health Service Foundation TrustBirminghamUnited Kingdom
- Academic Unit of OphthalmologyInstitute of Inflammation and Ageing, University of BirminghamBirminghamUnited Kingdom
| | - Pearse A. Keane
- Department of Ophthalmology, RigshospitaletUniversity of CopenhagenCopenhagenDenmark
| | - David P. Crabb
- Optometry and Visual SciencesCity, University of LondonLondonUnited Kingdom
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Orbach R, Schneebaum Sender N, Lubetzky R, Fattal-Valevski A. Increased Intracranial Pressure in Acute Disseminated Encephalomyelitis. J Child Neurol 2019; 34:99-103. [PMID: 30477374 DOI: 10.1177/0883073818811541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the intracranial pressure in pediatric acute disseminated encephalomyelitis using spinal tap opening pressure on lumbar puncture, which is routinely performed as part of suspected acute disseminated encephalomyelitis workup. Compared to other cerebrospinal fluid parameters such as cell count, protein concentration, and presence of oligoclonal bands, cerebrospinal fluid opening pressure is infrequently recorded. METHODS A retrospective chart review of demographic, clinical, and laboratory data of children diagnosed with acute disseminated encephalomyelitis admitted to a tertiary referral hospital between 2005 and 2016. RESULTS Of the 36 children diagnosed with acute disseminated encephalomyelitis, 24 had the cerebrospinal fluid opening pressure documented in their records. The mean cerebrospinal fluid opening pressure was 27.6±12.6 cmH2O, range 9-55 cmH2O (95% confidence interval 21.9-33.6). Cerebrospinal fluid opening pressure in the acute disseminated encephalomyelitis group was statistically significantly higher ( P = .0013, 95% confidence interval 4.2-15.0) than the accepted upper limit in this age group (18 cmH2O). In 10 of 24 patients (42%), the opening pressure was above 28 cmH2O. CONCLUSIONS Increased opening pressure was the most frequent cerebrospinal fluid abnormal finding in our cohort, which suggests a potential role of increased intracranial pressure in the acute disseminated encephalomyelitis pathophysiological disease mechanism. In certain cases, the opening pressure value could have monitoring and therapeutic implications, and therefore its measurement is highlighted by this study.
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Affiliation(s)
- Rotem Orbach
- 1 Pediatrics Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,2 Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Nira Schneebaum Sender
- 3 Pediatric Neurology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ronit Lubetzky
- 1 Pediatrics Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,2 Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Aviva Fattal-Valevski
- 2 Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.,3 Pediatric Neurology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Salpietro V, Polizzi A, Recca G, Ruggieri M. The role of puberty and adolescence in the pathobiology of pediatric multiple sclerosis. ACTA ACUST UNITED AC 2018. [DOI: 10.1186/s40893-017-0032-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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12
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an update on pediatric intracranial hypertension. RECENT FINDINGS The annual pediatric incidence is estimated at 0.63 per 100,000 in the USA and 0.71 per 100,000 in Britain. The Idiopathic Intracranial Hypertension Treatment Trial found improvement in visual fields, optical coherence tomography, Frisen grade, and quality of life with acetazolamide compared to placebo in adult patients, and these findings have been translated to the pediatric population. Pediatric intracranial hypertension is a disorder that if left untreated can lead to poor quality of life and morbidity. There are no current treatment studies in pediatrics, but adult data suggests acetazolamide remains an acceptable first-line medication.
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Affiliation(s)
- Shawn C Aylward
- Department of Neurology, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Amanda L Way
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, OH, USA
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13
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Abstract
Few diseases blur the margins between their childhood and adult-onset varieties as much as optic neuritis. This report will review our state of knowledge of pediatric optic neuritis, as well as its relationship to the latest consensus definitions of neuroinflammatory disease. Current diagnostic and treatment options will be explored, as well as our potential to uncover an understanding of pediatric optic neuritis through systematic prospective studies. The risk of evolving multiple sclerosis is probably less than in adults, but pediatric optic neuritis is more likely to be an initial manifestation of acute disseminated encephalomyelitis. Steroids may hasten visual recovery, but they do not change visual outcome except in cases because of neuromyelitis optica. The role of puberty in modifying the presentation and risk associations is unknown. Prospective studies are required to resolve these diagnostic and management issues.
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Gillson N, Jones C, Reem RE, Rogers DL, Zumberge N, Aylward SC. Incidence and Demographics of Pediatric Intracranial Hypertension. Pediatr Neurol 2017; 73:42-47. [PMID: 28668233 DOI: 10.1016/j.pediatrneurol.2017.04.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We analyzed the incidence and demographic features of pediatric intracranial hypertension. METHODS Inpatient and outpatient encounters of children aged 18 years or younger who were diagnosed with primary (idiopathic) or secondary intracranial hypertension between January 2010 and December 2013 were identified. Data were collected from a subspecialty clinic devoted to intracranial hypertension and the sole children's hospital in a large Midwestern city of the United States. Estimated incidence rates were calculated based on the number of newly diagnosed patients in our hospital's primary service area, which includes seven central Ohio counties. Sex, race, body mass index, socioeconomic status, and geographic distribution were also noted. RESULTS A total of 74 pediatric patients were diagnosed with intracranial hypertension (49 primary/idiopathic and 25 secondary) between January 2010 and December 2013. Using census data, we determined the pediatric population in our service area during the four-year period. The Ohio Hospital Association's database indicated that 92.3% of patients aged 0 to 17 years residing in the region sought care at our institution. By combining these data, we calculated an annual incidence of primary and secondary intracranial hypertension of 0.63 and 0.32 per 100,000 children, respectively. CONCLUSIONS The estimated annual incidence of pediatric primary intracranial hypertension in our seven county service area in central Ohio is similar to previous pediatric reports from other countries and is 67% of that reported in the US adult population.
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Affiliation(s)
- Natalie Gillson
- Division of Pediatric Neurology, Golisano Children's Hospital of Southwest Florida, Fort Myers, Florida
| | - Charlotte Jones
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | - Rachel E Reem
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio
| | - David L Rogers
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio
| | - Nicholas Zumberge
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Shawn C Aylward
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio.
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15
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Morgan-Followell B, Aylward SC. Comparison of Cerebrospinal Fluid Opening Pressure in Children With Demyelinating Disease to Children With Primary Intracranial Hypertension. J Child Neurol 2017; 32:366-370. [PMID: 27909013 DOI: 10.1177/0883073816681936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors aimed to compare the opening pressures of children with demyelinating disease to children with primary intracranial hypertension. Medical records were reviewed for a primary diagnosis of demyelinating disease, or primary intracranial hypertension. Diagnosis of demyelinating disease was made according to either the 2007 or 2012 International Pediatric Multiple Sclerosis Study Group criteria. Primary intracranial hypertension diagnosis was confirmed by presence of elevated opening pressure, normal cerebrospinal fluid composition and neuroimaging. The authors compared 14 children with demyelinating disease to children with primary intracranial hypertension in 1:1 and 1:2 fashions. There was a statistically significant higher BMI in the primary intracranial hypertension group compared to the demyelinating group ( P = .0203). The mean cerebrospinal fluid white blood cell count was higher in the demyelinating disease group compared to primary intracranial hypertension ( P = .0002). Among both comparisons, the cerebrospinal fluid opening pressure, glucose, protein and red blood cell counts in children with demyelinating disease were comparable to age- and sex-matched controls with primary intracranial hypertension.
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Affiliation(s)
| | - Shawn C Aylward
- 1 Department of Neurology, Nationwide Children's Hospital, Columbus, OH, USA
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Aylward SC, Reem RE. Pediatric Intracranial Hypertension. Pediatr Neurol 2017; 66:32-43. [PMID: 27940011 DOI: 10.1016/j.pediatrneurol.2016.08.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 10/21/2022]
Abstract
Primary (idiopathic) intracranial hypertension has been considered to be a rare entity, but with no precise estimates of the pediatric incidence in the United States. There have been attempts to revise the criteria over the years and adapt the adult criteria for use in pediatrics. The clinical presentation varies with age, and symptoms tending to be less obvious in younger individuals. In the prepubertal population, incidentally discovered optic disc edema is relatively common. By far the most consistent symptom is headache; other symptoms include nausea, vomiting tinnitus, and diplopia. Treatment mainstays include weight loss when appropriate and acetazolamide. Furosemide may exhibit a synergistic benefit when used in conjunction with acetazolamide. Surgical interventions are required relatively infrequently, but include optic nerve sheath fenestration and cerebrospinal fluid shunting. Pain and permanent vision loss are the two major complications of this disorder and these manifestations justify aggressive treatment. Once intracranial hypertension has resolved, up to two thirds of patients develop a new or chronic headache type that is different from their initial presenting headache.
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Affiliation(s)
- Shawn C Aylward
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio.
| | - Rachel E Reem
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio
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Aylward SC, Waslo CS, Au JN, Tanne E. Manifestations of Pediatric Intracranial Hypertension From the Intracranial Hypertension Registry. Pediatr Neurol 2016; 61:76-82. [PMID: 27255412 DOI: 10.1016/j.pediatrneurol.2016.04.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 04/06/2016] [Accepted: 04/09/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the presenting symptoms, demographics, and interventions in pediatric patients enrolled in the Intracranial Hypertension Registry. METHODS We analyzed confirmed intracranial hypertension patients ≤18 years at the time of initial diagnosis who were enrolled in the registry. RESULTS A total of 203 patients met the criteria for inclusion; 142 (70%) were considered primary intracranial hypertension. Females made up 72.5% (103 of 142) and 75.8% (47 of 61) in the primary intracranial hypertension and secondary intracranial hypertension groups, respectively. There were no clinically significant differences in age, body mass index, or opening pressure between the primary intracranial hypertension and secondary intracranial hypertension groups. Symptoms most often reported were headache and blurred vision. Bilateral optic disc edema occurred in 89.3% of primary intracranial hypertension and 78.7% of secondary intracranial hypertension patients. When divided into pre- and postpubertal status, 32.5% of patients were classified prepubertal; 77.3% of these had primary intracranial hypertension. This resulted in a female to male ratio of 1:1.04 for prepubertal and 6:1 for postpubertal primary intracranial hypertension patients. The body mass index was significantly higher in the postpubertal primary intracranial hypertension group (P = 0.0014). There was no significant difference in opening pressure. CONCLUSIONS The common symptoms of intracranial hypertension, including headache, optic disc edema, and vision changes, occurred with similar frequencies in our cohort to those reported in the literature. In separate subanalyses, we found significantly higher rates of obesity in postpubertal females with primary intracranial hypertension. The female-to-male ratios in the postpubertal primary intracranial hypertension and secondary intracranial hypertension groups were higher than reported in the literature.
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Affiliation(s)
- Shawn C Aylward
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio.
| | - Carin S Waslo
- Casey Eye Institute, Department of Ophthalmology, Intracranial Hypertension Registry, Oregon Health & Science University, Portland, Oregon
| | - Johnathan N Au
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, Illinois
| | - Emanuel Tanne
- Casey Eye Institute, Department of Ophthalmology, Intracranial Hypertension Registry, Oregon Health & Science University, Portland, Oregon; Casey Eye Institute, Oregon Health & Science University, Portland, Oregon
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Aylward SC, Aronowitz C, Roach ES. Intracranial Hypertension Without Papilledema in Children. J Child Neurol 2016; 31:177-83. [PMID: 26012507 DOI: 10.1177/0883073815587029] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/21/2015] [Indexed: 11/16/2022]
Abstract
This study aims to determine the frequency of intracranial hypertension without papilledema in children. Charts of patients evaluated in a pediatric intracranial hypertension clinic at our institution were retrospectively reviewed. The patients were divided into 2 groups depending on whether they had presence or absence of optic nerve edema at the time of presentation. Age, body mass index, and opening cerebrospinal fluid pressures were considered continuous variables and compared by Wilcoxon rank sum test because of non-normality. A P-value of 0.05 was considered significant. A total of 228 charts were reviewed; 152 patients met the criteria for intracranial hypertension, and 27 patients (17.8%) met the criteria of headache without optic nerve edema. There was no clinically significant difference in age, body mass index, opening pressure, and modified opening pressure between the 2 groups.
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Affiliation(s)
- Shawn C Aylward
- Department of Neurology, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA
| | | | - E Steve Roach
- Department of Neurology, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA
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