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Sverdlichenko I, Micieli JA. Idiopathic Intracranial Hypertension Presenting With Completely Asymmetric Visual Function. J Neuroophthalmol 2023; 43:e340-e342. [PMID: 36166779 DOI: 10.1097/wno.0000000000001641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Irina Sverdlichenko
- Faculty of Medicine (IS), University of Toronto, Toronto, Canada; Department of Ophthalmology & Vision Sciences (JAM), University of Toronto, Toronto, Canada; Division of Neurology (JAM), Department of Medicine, University of Toronto, Toronto, Canada; and Kensington Vision and Research Centre (JAM), Toronto, Canada
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Senderowich N, Bachar-Zipori A, Mitelpunkt A, Latzer IT, Klein A, Mezad-Koursh D, Fattal-Valevski A, Hausman-Kedem M. Predictors of disease course and long-term outcomes of idiopathic intracranial hypertension in children and adolescents. Eur J Pediatr 2023; 182:5137-5147. [PMID: 37691042 DOI: 10.1007/s00431-023-05173-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023]
Abstract
This study aimed to identify predictors for unfavorable disease course and clinical and visual outcomes in pediatric patients with idiopathic intracranial hypertension (IIH). Employing a multi-tiered approach, we retrospectively analyzed clinical, ophthalmic, and neuroimaging data from patients diagnosed with IIH between 2003 and 2021. Of the 97 patients included, 56 (58%) were females. The median age was 12 years [Interquartile range (IQR) 9, 14], and the median follow-up time was 39.0 months (IQR 14.8, 90.9). Forty-two (43%) patients had an unfavorable disease course, 28 (29%) had persistence of headache at last follow-up, and 16 (18%) had a poor visual outcome, most of them with mild visual disturbances. Poor visual outcome was more common in females compared to males [16/47 (34%) vs. 0/39, p < 0.001)]. On multivariate regression analysis, female sex and disease recurrence were significantly associated with poor visual outcomes (OR: 18.5, CI:1.3-270, P = 0.03, and OR: 5.1, CI: 1.2-22.5, P = 0.03, respectively). Patients with persistent headaches exhibited lower incidence of papilledema, lower opening pressure, and fewer neuroimaging markers indicating elevated intracranial pressure. CONCLUSIONS This study provides insights into predictive factors for an unfavorable disease course, persistent headaches, and poor visual outcomes in patients with childhood IIH. Patients with persistent headaches may have a variant of a chronic pain syndrome warranting a different therapeutic approach. WHAT IS KNOWN • Childhood-onset Idiopathic Intracranial hypertension (IIH) is a heterogenous disease. The knowledge on disease trajectory and long-term outcomes and its predictors is limited. WHAT IS NEW • A higher opening pressure and factors suggestive of the metabolic syndrome predict an unfavorable disease course whereas female sex and disease recurrence are significantly associated with poor visual outcomes • A third of the patients diagnosed with IIH experience ongoing headaches despite achieving favorable visual outcomes. This subset, characterized by lower disease-severity indicators at onset may represent a distinct subgroup warranting a different therapeutic approach.
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Affiliation(s)
| | - Anat Bachar-Zipori
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Alexis Mitelpunkt
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 6423906, Israel
| | - Itay Tokatly Latzer
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 6423906, Israel
| | - Ainat Klein
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Daphna Mezad-Koursh
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Ophthalmology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Aviva Fattal-Valevski
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 6423906, Israel
| | - Moran Hausman-Kedem
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 6423906, Israel.
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Mandura R, Khawjah D, Alharbi A, Arishi N. Visual outcomes of idiopathic intracranial hypertension in a neuro-ophthalmology clinic in Jeddah, Saudi Arabia. Saudi J Ophthalmol 2023; 37:25-31. [PMID: 36968767 PMCID: PMC10032278 DOI: 10.4103/sjopt.sjopt_173_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 06/26/2022] [Accepted: 01/31/2023] [Indexed: 03/12/2023] Open
Abstract
PURPOSE Idiopathic intracranial hypertension (IIH) is a disorder with elevated intracranial pressure more than 250 mm H2O, without evidence of meningeal inflammation, space-occupying lesion, or venous thrombosis. In this study, we aim to study the clinical profile, evaluation, management, and visual outcome in a hospital-based population of IIH cases in Jeddah. METHODS This is a retrospective observational cohort study that included the medical records of all patients referred to neuro-ophthalmology service for evaluation of papilledema. The medical records have been reviewed from October 2018 to February 2020 at Jeddah Eye Hospital, Saudi Arabia. A total of 51 patients presented with papilledema in the studied period. Forty-seven patients met our inclusion criteria and were included in the study. RESULTS The study found that the incidence rate of IIH is 16:100 of the referred cases to the neuro-ophthalmology clinic. Most of the patients were females (41, 91.2%), with a mean age of presentation of 32 ± 11 years. The most common presenting symptom was headache (40 patients, 88.8%), followed by transient visual obscuration (TVO) (20 patients, 44.4%), and reduced visual acuity (15 patients, 33.3%). All 45 patients were started on medical treatment with oral acetazolamide with four patients (8.8%) shifted to topiramate because of the lack of response or intolerance to acetazolamide while four patients (8.8%) underwent lumbar-peritoneal shunt because of inadequate control of the disease despite the treatment with medical therapy. For both eyes, the change in visual acuity across all assessment points was statistically significant. Nevertheless, there were no significant changes in the visual field findings among all of the compared assessment points. CONCLUSION The present study has shown that IIH-related papilledema is common in young female patients with headaches, TVOs, and reduced visual acuity. Those are the most common symptoms in our IIH population. Medical treatment and monitoring of IIH is efficient and should be considered to enhance the prognosis of IIH-related complications. In addition, the visual acuity and the visual field should be frequently monitored for these patients.
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Lyons HS, Mollan SLP, Liu GT, Bowman R, Thaller M, Sinclair AJ, Mollan SP. Different Characteristics of Pre-Pubertal and Post-Pubertal Idiopathic Intracranial Hypertension: A Narrative Review. Neuroophthalmology 2022; 47:63-74. [PMID: 36891406 PMCID: PMC9988343 DOI: 10.1080/01658107.2022.2153874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/10/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) affects both children and adults. There are currently no clinical trials in IIH for those who are adolescents or children. The aims of this narrative review were to characterise the differences between pre- and post-pubertal IIH and to highlight the need to be more inclusive in clinical trial planning and recruitment. A detailed search of the scientific literature was performed using the PubMed database, from inception until 30 May 2022 using keywords. This included English language papers only. The abstracts and full texts were reviewed by two independent assessors. The literature revealed that the pre-pubertal group had a more variable presentation. The presenting features in the post-pubertal paediatric group were more akin to adults with headache as the dominant feature. They were also more likely to be female and have an increased body mass index. A clear limitation of the literature was that a number of paediatric studies had variable inclusion criteria, including secondary causes of raised intracranial pressure. Pre-pubertal children do not display the same predilection towards the female sex and obesity as post-pubertal children, who have a similar phenotype to the adult cohort. Inclusion of adolescents in clinical trials should be considered given the similar phenotype to adults. There is a lack of consistency in the definition of puberty, making the IIH literature difficult to compare. Inclusion of secondary causes of raised intracranial pressure has the potential to confound the accuracy of analysis and interpretation of the results.
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Affiliation(s)
- Hannah S. Lyons
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | | | - Grant T. Liu
- Children's Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Richard Bowman
- Ophthalmology Department, Great Ormond Street Children’s Hospital, London, UK
| | - Mark Thaller
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Alexandra J. Sinclair
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK
| | - Susan P. Mollan
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham Neuro-Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
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Chiu HH, Reginald YA, Moharir M, Wan MJ. Visual outcomes in idiopathic intracranial hypertension in children. Can J Ophthalmol 2022; 57:376-80. [PMID: 34283970 DOI: 10.1016/j.jcjo.2021.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/20/2021] [Accepted: 06/15/2021] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The purpose of this study was to report the clinical characteristics and long-term visual outcomes in a cohort of children with idiopathic intracranial hypertension (IIH). DESIGN Retrospective, observational cohort study. PARTICIPANTS Consecutive children who met the diagnostic criteria for definite IIH at a tertiary care pediatric hospital between 2009 and 2020. METHODS The charts of pediatric patients with IIH were reviewed. The main outcome measure was long-term visual impairment, with an analysis of clinical features by age and risk factors for a poor visual outcome. RESULTS There were 110 children (75 females) with IIH. At presentation, younger children with IIH were less likely to present with headaches (p = 0.01) and more likely to be asymptomatic (p = 0.03). There was a strong association with female sex (p < 0.001) and higher body mass index (p < 0.001) in adolescents in comparison to younger children. Of the 90 patients with long-term visual outcome data, only 8 (9%) had evidence of mild visual impairment (1 loss of visual acuity, 7 loss of visual field) with no cases of severe visual impairment. On risk factor analysis, the only variable associated with a poor visual outcome was greater severity of papilledema at diagnosis. CONCLUSIONS In this large series of pediatric IIH, the long-term visual outcomes were favourable, with evidence of mild visual impairment in less than 10% of patients.
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Zafar S, Panthangi V, Cyril Kurupp AR, Raju A, Luthra G, Shahbaz M, Almatooq H, Foucambert P, Esbrand FD, Khan S. A Systematic Review on Whether an Association Exists Between Adolescent Obesity and Idiopathic Intracranial Hypertension. Cureus 2022; 14:e28071. [PMID: 36127965 PMCID: PMC9477550 DOI: 10.7759/cureus.28071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/16/2022] [Indexed: 11/19/2022] Open
Abstract
Pseudotumor cerebri syndrome (PTCS)/idiopathic intracranial hypertension (IIH) is a clinical presentation appertaining to signs/symptoms of raised intracranial pressure, like headache and papilledema. It is an uncommon but clinically significant cause of morbidity such as permanent vision loss. It is crucial to understand if idiopathic intracranial hypertension (IIH) is on the rise in adolescents, it is probably due to the rising prevalence of obesity worldwide. Our study aimed to find an association between obesity and IIH in adolescents. We utilized Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 (PRISMA) guidelines to run this systematic review. Many publications related to the topic in the discussion were scrutinized through a comprehensive database search. We filtered them down to a final count of 10 articles after utilizing our inclusion/exclusion criteria and assessing the quality of work. In these final papers, we identified several possibilities to explain the link between obesity and IIH in adolescents. Overweight and obese adolescents were found to have a significantly increased risk of IIH development, with a more severe clinical picture seen in morbidly obese female patients.
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Masri A, Al Jaberi M, Shihadat R, Rayyan A, AlMasri M, Abuna'meh L, Ali M, Al Ryalat N, Hadidy A, Al-Shakkah AA. Pseudotumor cerebri syndrome in children: Clinical characteristic and re-classification. Brain Dev 2022; 44:446-453. [PMID: 35393129 DOI: 10.1016/j.braindev.2022.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022]
Abstract
AIM To describe the clinical characteristics of children with pseudotumor cerebri syndrome (PTCS) who were diagnosed according to the modified Dandy criteria and to reclassify them according to the newly proposed diagnostic criteria by Freidman. METHODOLOGY This retrospective study included the period from January 2016-to July 2021. RESULTS 50 patients were included; 34 males and 16 females with a male to female ratio of 2.1:1. The average age at onset of symptoms was 8 years. Obesity was noticed in 6 (12%) patients; 34 (68%) had symptoms upon presentation. The most common presenting symptom was headache (28 patients; 56%), papilledema was present in 33 (66%) patients. Most patients (37; 74%) had an initial cerebrospinal fluid (CSF) pressure ≥280 mmH2O. At last follow-up, papilledema resolved in 11/32 (34.3%) patients, and headache resolved in 17/23 (74%) patients. 22/50 (44%) patients fulfilled the definite criteria proposed by Freidman, 11/50 (22%) fulfilled the probable, 10/50 (20%) were categorized as possible, and 7 (14%) patients were categorized as unmet. CONCLUSION PTCS is a chronic condition. Managing patients who do not have papilledema or who do not meet the newly proposed higher CSF pressure is challenging. Although, applying the newly proposed criteria captured most of our patients, however, around one quarter were managed based on clinical experience. This study indicates a strong need for future guidelines tailored specifically for children, taking into consideration that the cut-off point of CSF pressure might not be similar for all populations.
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Affiliation(s)
- Amira Masri
- Department of Paediatrics,division of child neurology , Faculty of Medicine, The University of Jordan.
| | | | | | | | | | - Lina Abuna'meh
- Department of Paediatrics,division of child neurology , Faculty of Medicine, The University of Jordan
| | - Majd Ali
- Department of Paediatrics,division of child neurology , Faculty of Medicine, The University of Jordan
| | - Nosaiba Al Ryalat
- Department of Radiology, Faculty of Medicine, The University of Jordan
| | - Azmy Hadidy
- Department of Radiology, Faculty of Medicine, The University of Jordan
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Chang MY, Yim CK, Borchert MS. Increase in Pediatric Pseudotumor Cerebri Syndrome Emergency Department Visits, Inpatient Admissions, and Surgeries During the COVID-19 Pandemic. J Neuroophthalmol 2022; 42:e87-e92. [PMID: 34803141 PMCID: PMC9842394 DOI: 10.1097/wno.0000000000001480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Pediatric pseudotumor cerebri syndrome (PTCS) is a vision-threatening condition that is associated with female sex and obesity in pubertal and postpubertal children. It is unknown whether the increase in childhood obesity during the COVID-19 pandemic has affected the rates and characteristics of pediatric PTCS. METHODS We conducted a retrospective study of children evaluated for PTCS (inpatient or emergency department) at our children's hospital before (March 19, 2015 to March 19, 2020) and during (March 20, 2020 to February 20, 2021) the pandemic. We compared the monthly number of inpatient and emergency department encounters for pediatric PTCS before and during the pandemic. In addition, anthropometric and ophthalmologic characteristics of children evaluated for pediatric PTCS before and during the pandemic were compared. RESULTS A total of 36 encounters in the 5 years before the pandemic and 26 encounters in the 11 months during the pandemic were identified. The median monthly number of encounters for pediatric PTCS was significantly higher during the pandemic compared with the 5 years before the pandemic (2 vs 0, P = 0.0021). Compared with prepandemic patients, children evaluated during the pandemic were older (median age 16 vs 14 years, P = 0.02), with higher rates of obesity (85% vs 66%, P = 0.05) and lower likelihood of reporting Caucasian race (4% vs 31%, P = 0.02). Pandemic patients had worse presenting visual acuity (median logMAR 0.14 vs 0.05, P = 0.05) and were more likely to have fulminant presentation (23% vs 6%, P = 0.04) and require surgical intervention (23% vs 6%, P = 0.04). CONCLUSIONS At our children's hospital, the rate of inpatient admissions and emergency department visits for pediatric PTCS increased during the pandemic. The severity of disease and frequency of surgical treatment also increased. Racial and ethnic minorities seem to be disproportionately affected. These changes may be related to increasing rates of childhood obesity during the pandemic.
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Affiliation(s)
- Melinda Y Chang
- Department of Ophthalmology, Roski Eye Institute, University of Southern California (MYC, CY, MSB), Los Angeles, California; and Vision Center at Children's Hospital Los Angeles (MYC, CY, MSB), Los Angeles, California
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Rufai SR, Jeelani NUO, Bowman R, Bunce C, Proudlock FA, Gottlob I. Recognition of intracranial hypertension using handheld optical coherence tomography in children (RIO Study): a diagnostic accuracy study protocol. BMJ Open 2022; 12:e048745. [PMID: 35017232 PMCID: PMC8753392 DOI: 10.1136/bmjopen-2021-048745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Paediatric intracranial hypertension (IH) is a rare but serious condition that can pose deleterious effects on the brain and vision. Estimating intracranial pressure (ICP) in children is difficult. Gold standard direct ICP measurement is invasive and carries risk. It is impractical to routinely perform direct ICP measurements over time for all children at risk of IH. This study proposes to assess the diagnostic accuracy of handheld optical coherence tomography (OCT), a non-invasive ocular imaging method, to detect IH in children. METHODS AND ANALYSIS This is a prospective study evaluating the diagnostic accuracy of handheld OCT for IH in at risk children. Inclusion criteria include clinical and/or genetic diagnosis of craniosynostosis, idiopathic intracranial hypertension, space occupying lesion or other conditions association with IH and age 0-18 years old. Exclusion criteria include patients older than 18 years of age and/or absence of condition placing the child at risk of IH. The primary outcome measures are handheld OCT and 48-hour ICP assessments, which will be used for diagnostic accuracy testing (sensitivity, specificity, positive predictive value, negative predictive value and accuracy). Main secondary outcome measures include visual acuity, fundoscopic examination, contrast sensitivity, visual field testing and visual evoked potentials, wherever possible. ETHICS AND DISSEMINATION Ethical approval was granted for this study by the East Midlands Nottingham 2 Research Ethics committee (UOL0348/IRAS 105137). Our findings will be disseminated through presentation at relevant meetings, peer-reviewed publication and via the popular media. TRIAL REGISTRATION NUMBER ISRCTN52858719.
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Affiliation(s)
- Sohaib R Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- Ulverscroft Eye Unit, University of Leicester, Leicester, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Noor Ul Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Richard Bowman
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catey Bunce
- Clinical Trials Unit, Royal Marsden Hospital NHS Trust, London, UK
| | | | - Irene Gottlob
- Ulverscroft Eye Unit, University of Leicester, Leicester, UK
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Al-Musalami A, Elmanzalawy A, Wali Y, Ganesh A. Secondary intracranial hypertension in aplastic anemia: A case report and review of current concepts. Oman J Ophthalmol 2021; 14:190-195. [PMID: 34880583 PMCID: PMC8597811 DOI: 10.4103/ojo.ojo_79_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 11/08/2022] Open
Abstract
Intracranial hypertension (IH) when detected mandates prompt and appropriate therapy to avoid permanent visual impairment. We report a 7-year-old boy who presented to the emergency services with purpuric rashes and bruises. Peripheral blood smear and bone marrow aspiration confirmed the diagnosis of aplastic anemia. During admission, the child developed headache, nausea, vomiting, and diplopia. Ophthalmic examination revealed intermittent esotropia and bilateral papilledema. The findings on neuroimaging and lumbar puncture led to the diagnosis of secondary IH (SIH). The intracranial pressure normalized on treatment with oral acetazolamide, oral furosemide, and intravenous dexamethasone.
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Affiliation(s)
- Adil Al-Musalami
- Ophthalmology Program, Oman Medical Specialty Board, Muscat, Oman
| | - Alaa Elmanzalawy
- Department of Radiology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Yasser Wali
- Department of Pediatric Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Anuradha Ganesh
- Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman
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Basiron SF'A, Tan EL, Ch'ng TW, Othman O. Idiopathic Intracranial Hypertension in a Malaysian Preschooler. Cureus 2021; 13:e19207. [PMID: 34877197 PMCID: PMC8642153 DOI: 10.7759/cureus.19207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2021] [Indexed: 11/05/2022] Open
Abstract
A four-year-old girl presented with a three-day history of squint and irritability. Examination showed reduced visual acuity in both eyes, the presence of a false localizing sign, and bilateral optic disc swelling. On investigation, her blood laboratory workup was within the normal range. Imaging of the brain showed no evidence of a space-occupying lesion or cerebral venous sinus thrombosis. The lumbar puncture opening pressure was 27cmH20 and the cerebrospinal fluid workup was normal. The diagnosis of idiopathic intracranial hypertension (IIH) was made based on the diagnostic criteria for pseudotumor cerebri syndrome. She was successfully treated with acetazolamide with resolved symptoms and signs. This highlights the possibility of IIH presenting with inconspicuous symptoms in preschool children, which needs a high index suspicion by clinicians. Hence, solving the challenges in the workup, especially in children, is very crucial.
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Affiliation(s)
- Siti Farhah 'Adilah Basiron
- Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS.,Ophthalmology, Hospital Raja Permaisuri Bainun, Perak, MYS
| | - Ee Ling Tan
- Ophthalmology, Hospital Raja Permaisuri Bainun, Perak, MYS
| | - Tun Wang Ch'ng
- Ophthalmology, Hospital Raja Permaisuri Bainun, Perak, MYS
| | - Othmaliza Othman
- Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
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Tokatly Latzer I, Senderowich N, Fattal-Valevski A, Mitelpunkt A, Uliel-Sibony S, Hausman-Kedem M. Disordered Eating Behaviors in Young Individuals With Idiopathic Intracranial Hypertension. Pediatr Neurol 2021; 125:1-8. [PMID: 34563874 DOI: 10.1016/j.pediatrneurol.2021.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The objective of this study was to assess the prevalence of disordered eating behaviors (DEBs) in young individuals with idiopathic intracranial hypertension (IIH) and to identify predictors of DEBs in this population. METHODS Individuals with IIH aged eight to 25 years and their matched controls responded to a self-rating survey comprised of the Eating Attitude Test-26 for assessing the presence of DEBs and the Depression, Anxiety and Stress Scale. RESULTS Fifty-three subjects with IIH and 106 healthy controls were included. DEBs were significantly more prevalent in individuals with IIH (P < 0.001). Individuals with IIH and DEBs were more likely to have longer periods of treatment [odds ratio: 1.07, 95% CI: 1.02-1.41), P = 0.008] and to have lost a significant amount of weight during the course of treatment [odds ratio: 9.06 (95% CI: 1.30-62.9), P = 0.026]. Depression, anxiety, and stress were more prevalent in the IIH group than in the controls (P = 0.004) and were associated with DEBs in these individuals (P = 0.01). CONCLUSIONS There is an increased prevalence of DEBs among young individuals with IIH, which persists even after disease resolution, and is associated with higher reported rates of depression, anxiety, and stress. Medical caregivers should have heightened awareness to DEBs in individuals with IIH with the aim of early identification and intervention.
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Affiliation(s)
- Itay Tokatly Latzer
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Noam Senderowich
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviva Fattal-Valevski
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexis Mitelpunkt
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shimrit Uliel-Sibony
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Hausman-Kedem
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Hoyos-Martinez A, Horne VE, Wood AC, Shah V. Prevalence of Adrenal Insufficiency and Glucocorticoid Use in Pediatric Pseudotumor Cerebri Syndrome. J Neuroophthalmol 2021; 41:e451-e457. [PMID: 33110007 DOI: 10.1097/wno.0000000000001111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The pathophysiology underlying pseudotumor cerebri syndrome (PTCS) is complex and not well understood. There are clear differences between PTCS in adults and pediatrics. Few and isolated case reports have suggested that adrenal function may be involved, yet no large cohort study has examined this relationship. METHODS We conducted a retrospective single-center study of children who presented with a diagnosis of PTCS and had cortisol testing measured between January 2010 and September 2019. We included all subjects meeting the revised PTCS diagnostic criteria after the chart review. Based on morning, random or 1-μg cosyntropin stimulated cortisol levels, adrenal functioning was classified as: (1) insufficient (peak cortisol <16 μg/dL and AM cortisol <5 μg/dL), (2) at risk (peak cortisol 16-20 μg/dL, AM cortisol 5-13 μg/dL, or random <13 μg/dL), or (3) sufficient (peak cortisol >20 μg/dL and AM or random cortisol >13 μg/dL). RESULTS A total of 398 individuals were reviewed, and 64 were included for analysis. Of these, 40.6% were men, of mixed race and ethnicity with a mean age of 10.5 (SD 4.7) years. Of these, 23% and 52% had insufficient or at-risk cortisol levels. The majority of those in the insufficient (70%) or at-risk (80%) groups were exposed to topical, nasal, or inhaled glucocorticoids but not systemic. Only 60% and 12% of those with PTCS with insufficient or at-risk cortisol testing, respectively, underwent definitive testing with a stimulation test. CONCLUSIONS Glucocorticoid use and hypocortisolism are prevalent in PTCS and need consideration as a potential underlying cause. Most children had insufficient or at-risk cortisol levels, and many did not undergo further testing/workup. Children who present with PTCS, particularly young, males should be evaluated for adrenal insufficiency and its risk factors, including nonsystemic steroids. Prospective studies are necessary to further evaluate the effect of cortisol in relation to pediatric PTCS.
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Affiliation(s)
- Alfonso Hoyos-Martinez
- Department of Pediatrics, Section of Pediatric Diabetes and Endocrinology (AH-M, VEH), Baylor College of Medicine | Texas Children's Hospital, Houston, Texas; USDA/ARS Children's Nutrition Research Center (ACW), Houston, Texas; Department of Ophthalmology (VS), Baylor College of Medicine, Houston, Texas; Cincinnati Children's Hospital Medical Center (VS), Abrahamson Pediatric Eye Institute/Division of Pediatric Ophthalmology, Cincinnati, Ohio; and Department of Ophthalmology (VS), University of Cincinnati, Cincinnati, Ohio
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Kamali A, Aein A, Naderi N, Choi SJ, Doyle N, Butler IJ, Huisman TAGM, Bonfante EE, Sheikh-Bahaei N, Khanpara S, Patel RP, Riascos RF, Zhang X, Tang RA, Radmanesh A. Neuroimaging Features of Intracranial Hypertension in Pediatric Patients With New-Onset Idiopathic Seizures, a Comparison With Patients with Confirmed Diagnosis of Idiopathic Intracranial Hypertension: A Preliminary Study. J Child Neurol 2021; 36:1103-1110. [PMID: 34747259 DOI: 10.1177/08830738211045234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
A cutoff value of 6.0 mm for optic nerve sheath dilation may be used as a screening imaging marker to suspect elevated opening pressure with specificity of 88% in pediatric patients with new-onset idiopathic seizures.
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Affiliation(s)
- Arash Kamali
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Azin Aein
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Niyousha Naderi
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sally J Choi
- 12339University of Texas Medical School, Health Science Center at Houston, Houston, TX, USA
| | - Nathan Doyle
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ian J Butler
- Department of Pediatrics, Division of Pediatric Neurology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Thierry A G M Huisman
- Departments of Pediatrics and Radiology, 3984Texas Children Hospital, 3989Baylor College of Medicine, Houston, TX, USA
| | - Eliana E Bonfante
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nasim Sheikh-Bahaei
- Department of Diagnostic Radiology, Division of Neuroradiology, Keck School of Medicine, 12223University of Southern California, Los Angeles, CA, USA
| | - Shekhar Khanpara
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rajan P Patel
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Roy F Riascos
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xu Zhang
- Department of Diagnostic Radiology, Division of Neuroradiology, 12340University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Rosa A Tang
- Department of Neurosurgery, Neuro-ophthalmology, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Alireza Radmanesh
- Department of Diagnostic Radiology, Division of Neuroradiology, 12297Langone Medical Center, New York University, New York, NY, USA
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Jensen AK, Sheldon CA, Paley GL, Szperka CL, Liu GW, Liu GT, McCormack SE. Autism Spectrum Disorder in Pediatric Idiopathic Intracranial Hypertension. Life (Basel) 2021; 11:972. [PMID: 34575122 PMCID: PMC8465615 DOI: 10.3390/life11090972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/23/2021] [Accepted: 08/30/2021] [Indexed: 12/27/2022] Open
Abstract
In recent years, the substantial burden of medical comorbidities in autism spectrum disorder (ASD) populations has been described. We report a retrospective observational case series of pediatric patients with suspected idiopathic intracranial hypertension (IIH) and concurrent ASD. Pediatric subjects with suspected IIH aged 2-18 years were identified by review of a pediatric neuro-ophthalmologist's database spanning from July 1993 to April 2013. ASD diagnoses were identified within this cohort by an ICD-9 diagnosis code search and database review. Three subjects had concurrent ASD diagnoses; all were non-obese males. Since the retrospective observational case series was performed in April 2013, we identified three additional IIH cases in boys with ASD. Our experience suggests that IIH may be a comorbidity of ASD, particularly in non-obese boys.
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Affiliation(s)
- Anne K. Jensen
- Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (A.K.J.); (C.A.S.); (G.L.P.)
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; (C.L.S.); (S.E.M.)
| | - Claire A. Sheldon
- Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (A.K.J.); (C.A.S.); (G.L.P.)
- Department of Ophthalmology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Grace L. Paley
- Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (A.K.J.); (C.A.S.); (G.L.P.)
- Department of Ophthalmology, Washington University, St. Louis, MO 63110, USA
| | - Christina L. Szperka
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; (C.L.S.); (S.E.M.)
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Geraldine W. Liu
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
| | - Grant T. Liu
- Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA; (A.K.J.); (C.A.S.); (G.L.P.)
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; (C.L.S.); (S.E.M.)
| | - Shana E. McCormack
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; (C.L.S.); (S.E.M.)
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
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Morden FTC, Tan C, Carrazana E, Viereck J, Liow KK, Ghaffari-Rafi A. Characterizing idiopathic intracranial hypertension socioeconomic disparities and clinical risk factors: A retrospective case-control study. Clin Neurol Neurosurg 2021; 208:106894. [PMID: 34455402 DOI: 10.1016/j.clineuro.2021.106894] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Against the backdrop of the diverse minority-majority state of Hawaii, this study seeks to better characterize associations between idiopathic intracranial hypertension (IIH) with sociodemographic variables and medical comorbidities. METHODS A retrospective case-control study was conducted by utilizing 54 IIH patients and 216 age-, sex-, and race-matched controls, 216 unmatched controls, and 63 age-, sex-, and race-matched migraine patients. RESULTS Relative to controls, IIH were 25 years younger (p < 0.0001) and 10.18 kg/m2 heavier (p < 0.0001), as well as exhibited greater odds of the following variables (p < 0.05): female (odds ratio [OR]: 8.87), the lowest income quartile (OR: 2.33), Native Hawaiian or other Pacific Islander (NHPI; OR: 2.23), Native American or Alaskan Native (OR: 16.50), obesity class 2 (35.0-39.9 kg/m2; OR: 4.10), obesity class 3 (>40 kg/m2; OR: 6.10), recent weight gain (OR: 11.66), current smoker (OR: 2.48), hypertensive (OR: 3.08), and peripheral vascular disease (OR: 16.42). Odds of IIH were reduced (p < 0.05) for patients who were Asian (OR: 0.27) or students (OR: 0.30;). Unique from Whites, NHPI IIH patients exhibited greater odds (p < 0.05) for being from lower socioeconomic status and currently smoking, as well as potential association with seizures (p = 0.08). Compared to migraines, IIH headaches were at increased odds of occurring (p < 0.05) occipitally, for greater than 15 days per month, aggravated by postural changes, and comorbid with dizziness and tinnitus. CONCLUSIONS These results not only better characterize IIH, but also highlight socioeconomic and racial disparities in diagnosis.
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Affiliation(s)
| | - Charissa Tan
- University of Hawaii at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA
| | - Enrique Carrazana
- University of Hawaii at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA; Hawaii Pacific Neuroscience, Brain Research, Innovation and Translation Lab, Honolulu, HI, USA
| | - Jason Viereck
- University of Hawaii at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA; Hawaii Pacific Neuroscience, Brain Research, Innovation and Translation Lab, Honolulu, HI, USA
| | - Kore Kai Liow
- University of Hawaii at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA; Hawaii Pacific Neuroscience, Brain Research, Innovation and Translation Lab, Honolulu, HI, USA
| | - Arash Ghaffari-Rafi
- University of Hawaii at Mānoa, John A. Burns School of Medicine, Honolulu, HI, USA; University of California, Davis, School of Medicine, Department of Neurological Surgery, Sacramento, CA, USA.
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Shimony N, Martinez-Sosa M, Osburn B, Jallo GI. Non-traumatic pediatric intracranial hypertension: key points for different etiologies, diagnosis, and treatment. Acta Neurol Belg 2021; 121:823-36. [PMID: 33829371 DOI: 10.1007/s13760-021-01626-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/02/2021] [Indexed: 12/30/2022]
Abstract
Intracranial hypertension can be an acute life-threatening event or slowly deteriorating condition, leading to a gradual loss of neurological function. The diagnosis should be taken in a timely fashioned process, which mandates expedite measures to save brain function and sometimes life. An optimal management strategy is selected according to the causative etiology with a core treatment paradigm that can be utilized in various etiologies. Distinct etiologies are intracranial bleeds caused by traumatic brain injury, spontaneous intracranial hemorrhage (e.g., neonatal intraventricular hemorrhage), or the rare pediatric hemorrhagic stroke. The other primary pediatric etiologies for elevated intracranial pressure are intracranial mass (e.g., brain tumor) and hydrocephalus related. Other unique etiologies in the pediatric population are related to congenital diseases, infectious diseases, metabolic or endocrine crisis, and idiopathic intracranial pressure. One of the main goals of treatment is to alleviate the growing pressure and prevent the secondary injury to brain parenchyma due to inadequate blood perfusion and eventually inadequate parenchymal oxygenation and metabolic state. Previous literature discussed essential characteristics of the treatment paradigm derived mainly from pediatric brain traumatic injuries' treatment methodology. Yet, many of these etiologies are not related to trauma; thus, the general treatment methodology must be tailored carefully for each patient. This review focuses on the different possible non-traumatic etiologies that can lead to intracranial hypertension with the relevant modification of each etiology's treatment paradigm based on the current literature.
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Malem A, Sheth T, Muthusamy B. Paediatric Idiopathic Intracranial Hypertension (IIH)-A Review. Life (Basel) 2021; 11:life11070632. [PMID: 34209834 PMCID: PMC8307434 DOI: 10.3390/life11070632] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/08/2021] [Accepted: 06/23/2021] [Indexed: 12/16/2022] Open
Abstract
Paediatric idiopathic intracranial hypertension (IIH), is a rare but important differential diagnosis in children presenting with papilloedema. It is characterised by raised intracranial pressure in the absence of an identifiable secondary structural or systemic cause and is, therefore, a diagnosis of exclusion. In the adult population, there is a strong predilection for the disease to occur in female patients who are obese. This association is also seen in paediatric patients with IIH but primarily in the post-pubertal cohort. In younger pre-pubertal children, this is not the case, possibly reflecting a different underlying disease aetiology and pathogenesis. Untreated IIH in children can cause significant morbidity from sight loss, chronic headaches, and the psychological effects of ongoing regular hospital monitoring, interventions, and medication. The ultimate goal in the management of paediatric IIH is to protect the optic nerve from papilloedema-induced optic neuropathy and thus preserve vision, whilst reducing the morbidity from other symptoms of IIH, in particular chronic headaches. In this review, we will outline the typical work-up and diagnostic process for paediatric patients with suspected IIH and how we manage these patients.
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Dafallah MA, Habour E, Ragab EA, Shouk ZM, Izzadden M. Idiopathic intracranial hypertension with multiple cranial nerve palsies in 10 years old thin Sudanese boy: case report. Egypt J Neurol Psychiatr Neurosurg 2021; 57:85. [PMID: 34220193 PMCID: PMC8241201 DOI: 10.1186/s41983-021-00339-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Idiopathic intracranial hypertension is a rare neurological disorder of unknown etiology. It is characterized by symptoms and signs of raise intra cranial pressure, normal brain neuroimaging, and high opening pressure ≥ 280 cm H2O in the presence of normal cerebro spinal fluid constituents. Case presentation Ten years old thin boy presented with severe throbbing headache, vomiting, and visual obscurations for a duration of 10 days. Physical examination revealed body mass index of 14.8, VI and VII cranial nerve palsies. Fudoscopy showed grade 4 papilledema; brain CT and MRI were normal. Lumbar puncture revealed pressure of 300 cm H2O with normal CSF constituents. He was treated with acetazolamide, methylprednisolone, and paracetamol. Conclusion Pediatricians need to be more aware of idiopathic intracranial hypertension as it can lead to permanent vision loss.
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Gilbert AL, Vaughn J, Whitecross S, Robson CD, Zurakowski D, Heidary G. Magnetic Resonance Imaging Features and Clinical Findings in Pediatric Idiopathic Intracranial Hypertension: A Case-Control Study. Life (Basel) 2021; 11:487. [PMID: 34071738 DOI: 10.3390/life11060487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/15/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study is to identify salient magnetic resonance imaging (MRI) findings of pediatric IIH, to determine the relevance of these findings with regard to disease pathogenesis, and to relate these findings to the clinical presentation towards identification of risk factors of disease. A retrospective, a case–control study of 38 pediatric patients with and 24 pediatric patients without IIH from the ophthalmology department at a tertiary care center was performed. Clinical data, including ophthalmic findings and lumbar puncture results, were recorded. Neuroimaging, including both MRI and magnetic resonance venography (MRV), was evaluated for perioptic subarachnoid space diameter enlargement, posterior globe flattening, optic nerve head protrusion, empty or partially empty sella turcica, dural venous sinus abnormalities, skull base crowding, and prominent arachnoid granulations. Compared with controls, IIH patients had larger perioptic subarachnoid space diameters, higher incidences of posterior globe flattening, protrusion of the optic nerve heads, an empty sella turcica, and dural venous sinus abnormalities. A perioptic subarachnoid space diameter of ≥5.2 mm was identified as an independent predictor of IIH (p < 0.001) with sensitivity of 87% and specificity of 67%. Several significant MRI findings in pediatric IIH were identified. Using a model that uniquely incorporated clinical and MRI findings at presentation, we provide a framework for risk stratification for the diagnosis of pediatric IIH which may be utilized to facilitate diagnosis. Future prospective work is needed to further validate the model developed in this study.
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Abstract
Pseudotumor cerebri also known as idiopathic intracranial hypertension is a relatively uncommon disorder of unknown pathophysiology. Although pseudotumor cerebri occurs in both children and adults, the pseudotumor cerebri literature is heavily dominated by adult studies. The aim of this study is to retrospectively describe the clinical presentation, imaging, treatment, and outcomes of a large pediatric pseudotumor cerebri population over a 23-year period. We also discuss secondary pseudotumor cerebri (44%) as well as the increasingly recognized patient subgroups without headache (13.3%) and without papilledema (7.3%). Female sex, obesity, and initial symptoms were consistent with the literature; however radiographic findings were surprisingly low in this cohort. Headache outcomes at 1 week, 1 month, and 3 months following initial lumbar puncture/treatment and visual function outcomes are reported.
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Affiliation(s)
- Erin Yamamoto
- 443553Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Darren Farber
- Norton Children's Medical Group, 204841The University of Louisville, Louisville, KY, USA
| | - David Rothner
- 443553Cleveland Clinic, Neurological Institute, Center for Pediatric Neurology, Cleveland, OH, USA
| | - Manikum Moodley
- 443553Cleveland Clinic, Neurological Institute, Center for Pediatric Neurology, Cleveland, OH, USA
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Muhlbauer Avni M, Yosha-Orpaz N, Konen O, Goldenberg-Cohen N, Straussberg R. Association of pediatric idiopathic intracranial hypertension with olfactory performance. Eur J Paediatr Neurol 2021; 30:162-169. [PMID: 33129661 PMCID: PMC7532354 DOI: 10.1016/j.ejpn.2020.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess the association between pediatric Idiopathic intracranial hypertension (IIH) and olfactory performance. METHODS A cross-sectional comparative study was conducted including 17 patients under 18 years diagnosed with IIH at a tertiary hospital and 17 healthy age- and sex-matched subjects. All participants underwent the semi-objective chemosensory Sniffin' Sticks test for evaluation of odor threshold (OT), indicative of peripheral olfactory function, and odor identification (OI), reflecting higher cognitive olfactory processing. Scores were compared and referred to the updated normative values. Demographic, clinical, and neuroimaging data were collected from the medical files. The patients with IIH were reassessed for olfactory function and clinical state at the subsequent follow-up, under treatment. RESULTS Compared to controls, the IIH group had a significantly lower mean OT score (6.41 ± 3.43 vs 10.21 ± 2.79, p = 0.001) and higher rate of OT score below the 10th percentile for age and sex according to the normative values (47.1% vs 0%, p = 0.001). There was no significant between-group difference in mean OI scores (9.82 ± 1.63, vs 10.59 ± 1.84, p = 0.290). OT scores were not associated with sex, age, body mass index, neuroimaging abnormalities, or lumbar puncture opening pressure. At the follow-up assessment, the OT scores were improved (9.36 ± 4.17 vs 6.7 ± 3.32, p = 0.027) whereas the OI scores were unchanged (9.88 ± 2.5 vs 9.69 ± 1.58, p = 0.432). CONCLUSIONS As reported in adults, children and adolescents with IIH appear to have a selective reversible deficit in olfactory detection threshold, which may imply a reduction in peripheral olfactory perceptual ability. Future studies should examine the predictive value of olfactory function for IIH.
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Affiliation(s)
- Maya Muhlbauer Avni
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel.
| | - Naama Yosha-Orpaz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel; Department of Pediatrics A, Schneider Children's Medical Center of Israel, Petach Tikva, 4920235, Israel.
| | - Osnat Konen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel; Department of Imaging, Schneider Children's Medical Center of Israel, Petach Tikva, 4920235, Israel.
| | - Nitza Goldenberg-Cohen
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel; Pediatric Ophthalmology Unit, Schneider Children's Medical Center of Israel, Petach Tikva, 4920235, Israel.
| | - Rachel Straussberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 6997801, Israel; Neurology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, 4920235, Israel.
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Abstract
Importance Pediatric pseudotumor cerebri syndrome pathophysiology is complex and not well delineated. Therefore, it is important to identify potential contributors or targets underlying the primary pathogenesis for its development. Objective To report cases highlighting the association of pediatric pseudotumor cerebri syndrome with adrenal insufficiency. Design, Setting, and Participants This noncontrolled, observational case series included pediatric patients diagnosed with pseudotumor cerebri syndrome and adrenal insufficiency at an urban academic children's hospital in Houston, Texas, from June 2015 to October 2019. Main Outcomes and Measures Monitoring optic nerve edema by clinical examination, fundus photography, and optical coherence topography images of the optic nerve. Results Data were collected from 5 pediatric patients (age range, 5-10 years) diagnosed with pseudotumor cerebri syndrome and adrenal insufficiency. One was a girl; all were White and prepubertal. Three patients had unrecognized glucocorticoid exposure. All patients had bilateral optic nerve edema that was initially treated with acetazolamide or topiramate, but cortisol functional testing by either 8 am cortisol or cosyntropin stimulation tests revealed a diagnosis of central adrenal insufficiency. Treatment with physiological doses of hydrocortisone resulted in resolution of optic nerve edema and clinical symptoms of pseudotumor cerebri syndrome, as well as a shorter time receiving medical therapy. Conclusions and Relevance In this case series, adrenal insufficiency was associated with both primary and secondary prepubertal pediatric pseudotumor cerebri syndrome. As a potential target specific to causative mechanism, physiologic hydrocortisone therapy resolved the condition. To date, there remains a global unawareness among clinicians about the suppressive outcome that glucocorticoids may have on the developing hypothalamic-pituitary-adrenal axis, resulting in adrenal insufficiency and so-called episodic pseudotumor cerebri syndrome in young children. Ophthalmologists and pediatric subspecialists should implement cortisol testing via either 8 am cortisol or cosyntropin stimulation tests at initial evaluation of all children with pseudotumor cerebri syndrome and risk factors for adrenal insufficiency, no predisposing causes, or nonresponse to conventional treatment. Further management and treatment should be in combination with ophthalmology and endocrine services.
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Affiliation(s)
- Veeral Shah
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas.,Abrahamson Pediatric Eye Institute, Division of Pediatric Ophthalmology, Department of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Ophthalmology, University of Cincinnati, Cincinnati, Ohio
| | - Alfonso Hoyos-Martinez
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston
| | - Vincent E Horne
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston
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Interlandi E, Pellegrini F, De Luca M, Cerullo G, De Falco A, De Marco R, Tortori A, Lee AG. Complete bilateral ophthalmoplegia in malignant intracranial hypertension in a child. Eur J Ophthalmol 2020; 32:1120672120966562. [PMID: 33081535 DOI: 10.1177/1120672120966562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe a case of fulminant idiopathic intracranial hypertension (IIH) in a child with "malignant" presentation. CASE REPORT A 16-year-old, previously healthy, girl presented with bilateral visual loss and bilateral global limitation of eye movements in the absence of headache. Extensive laboratory evaluation for infectious, inflammatory, autoimmune, and neoplastic conditions was negative. Magnetic resonance imaging (MRI) of the brain and lumbar puncture findings were consistent with a diagnosis of IIH. Extraocular motility improved in the next few days as well as optic disc edema but visual acuity remained poor. CONCLUSION The authors believe that the acute, severe, and fulminant ("malignant") presentation with markedly elevated intracranial pressure may produce the unique presentation of severe vision loss and bilateral complete ophthalmoplegia. Interestingly, there was no headache. To our knowledge this is the first such case to be reported in the English language ophthalmic literature.
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Affiliation(s)
- Emanuela Interlandi
- Department of Ophthalmology, "Ospedale del Mare", ASL Napoli 1-Centro, Naples, Campania, Italy
| | | | - Marco De Luca
- Department of Ophthalmology, "Ospedale del Mare", ASL Napoli 1-Centro, Naples, Campania, Italy
| | - Giovanni Cerullo
- Department of Neurology, "Ospedale del Mare", ASL Napoli 1-Centro, Naples, Campania, Italy
| | - Arturo De Falco
- Department of Neurology, "Ospedale del Mare", ASL Napoli 1-Centro, Naples, Campania, Italy
| | - Rocco De Marco
- Department of Ophthalmology, "Ospedale del Mare", ASL Napoli 1-Centro, Naples, Campania, Italy
| | - Achille Tortori
- Department of Ophthalmology, "Ospedale del Mare", ASL Napoli 1-Centro, Naples, Campania, Italy
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Departments of Ophthalmology, The University of Texas Medical Branch (UTMB), Galveston, TX, USA
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Texas A&M College of Medicine, College Station, TX, USA
- Baylor College of Medicine, Center for Space Medicine, Houston, TX, USA
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- University at Buffalo, Buffalo, NY, USA
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Ghaffari-Rafi A, Mehdizadeh R, Ko AWK, Ghaffari-Rafi S, Leon-Rojas J. Idiopathic Intracranial Hypertension in the United States: Demographic and Socioeconomic Disparities. Front Neurol 2020; 11:869. [PMID: 33013623 PMCID: PMC7506031 DOI: 10.3389/fneur.2020.00869] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/08/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Obesity's risk increases for low-income, female, young, and Black patients. By extrapolation, idiopathic intracranial hypertension (IIH)—a disease associated with body mass index—would potentially display socioeconomic and demographic disparities. Methods: IIH incidence (per 100,000) was investigated with respect to sex, age, income, residence, and race/ethnicity, by querying the largest United States (US) healthcare administrative dataset (1997–2016), the National (Nationwide) Inpatient Sample. Results: Annual national incidence (with 25th and 75th quartiles) for IIH was 1.15 (0.91, 1.44). Females had an incidence of 1.97 (1.48, 2.48), larger (p = 0.0000038) than males at 0.36 (0.26, 0.38). Regarding age, largest incidence was among those 18–44 years old at 2.47 (1.84, 2.73). Low-income patients had an incidence of 1.56 (1.47, 1.82), larger (p = 0.00024) than the 1.21 (1.01, 1.36) of the middle/high. No differences (χ2 = 4.67, p = 0.097) were appreciated between urban (1.44; 1.40, 1.61), suburban (1.30; 1.09, 1.40), or rural (1.46; 1.40, 1.48) communities. For race/ethnicity (χ2 = 57, p = 2.57 × 10−12), incidence was largest for Blacks (2.05; 1.76, 2.74), followed by Whites (1.04; 0.79, 1.41), Hispanics (0.67; 0.57, 0.94), and Asian/Pacific Islanders (0.16; 0.11, 0.19). Year-to-year, incidence rose for all strata subsets except Asian/Pacific Islanders (τ = −0.84, p = 0.00000068). Conclusion: IIH demonstrates several sociodemographic disparities. Specifically, incidences are larger for those low-income, Black, 18–44 years old, or female, while annually increasing for all subsets, except Asian/Pacific Islanders. Hence, IIH differentially afflicts the US population, yielding in healthcare inequalities.
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Affiliation(s)
- Arash Ghaffari-Rafi
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, United States.,Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Rana Mehdizadeh
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Andrew Wai Kei Ko
- John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, HI, United States
| | | | - Jose Leon-Rojas
- Queen Square Institute of Neurology, University College London, London, United Kingdom.,Universidad Internacional del Ecuador Escuela de Medicina, Quito, Ecuador
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Abstract
INTRODUCTION Intracranial hypertension (ICH) in children can have deleterious effects on the brain and vision. It is notoriously difficult to estimate intracranial pressure (ICP) in children and existing methods deliver suboptimal diagnostic accuracy to be used as screening tools. Optical coherence tomography (OCT) may represent a valuable, non-invasive surrogate measure of ICP, as has been demonstrated in a number of associated conditions affecting adults. More recently, OCT has been employed within the paediatric age group. However, the role of OCT in detecting ICH in children has not been rigorously assessed in a systematic review for all relevant conditions. Here, we propose a systematic review protocol to examine the role of OCT in the detection of ICH in children. METHODS AND ANALYSIS Electronic searches in the Cochrane Central Register of Controlled Trials, Medline, Embase, Web of Science and PubMed will identify studies featuring OCT in detecting ICH in children. Two independent screeners will identify studies for inclusion using a screening questionnaire. The systematic search and screening will take place between 2 April 2020 and 1 June 2020, while we aim to complete data analysis by 1 September 2020. Quality assessment will be performed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The primary outcome measure is the sensitivity and specificity of OCT in detecting ICH in children. Secondary outcomes measures include conditions associated with ICH per study, direct ICP monitoring, sensitivity and specificity of other measures for ICP and OCT parameters used. ETHICS AND DISSEMINATION Ethical approval is not required for the proposed systematic review as no primary data will be collected. The findings will be disseminated through presentations at scientific meetings and peer-reviewed journal publication. PROSPERO REGISTRATION NUMBER CRD42019154254.
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Affiliation(s)
- Sohaib R Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Noor Ul Owase Jeelani
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
- Developmental Biology & Cancer Dept, UCL GOS Institute of Child Health, London, United Kingdom
| | - Rebecca J McLean
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, United Kingdom
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Wang Y, Mcclelland C, Lee S, Lee MS. Pseudotumor cerebri in a transgender woman: case report and literature review. Can J Ophthalmol 2020; 55:e110-2. [DOI: 10.1016/j.jcjo.2019.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/05/2019] [Accepted: 09/26/2019] [Indexed: 02/07/2023]
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Abstract
INTRODUCTION Although considered uncommon, pseudotumor cerebri syndrome (PTC) is a significant cause of headache among children and adults. However, the presenting symptoms may be different among diverse age groups. In the present study, we compared the risk factors and clinical presentation of PTC across life-from childhood to adulthood. METHODS A retrospective survey of PTC patients aged 7 years or older between 2011 and 2013 was carried out. Pooled analyses were performed comparing characteristics from our data with those of published data subdivided into 3 age groups: pre-young children, adolescents, and adults. RESULTS Our cohort consisted of 72 patients: 32 children (10 pre-young children, 22 adolescents) and 40 adults. Within the pre-young children age group: 20% were females versus 82% in the adolescent age group and 85% of the adult age group. Obesity was found in 10% of the young children group, 64% of the adolescents, and 80% of the adults. Headache was reported in 70% young children, 82% adolescents, and 83% adults. Pooled analysis of 1499 patients showed that young children with PTC tend to complain less about headache compared with older ones. Vomiting and visual impairment were most common among adolescents, and dizziness and tinnitus were most common in adults. CONCLUSION PTC has different risk factors and clinical presentation throughout life. In young children, there is no gender preference and most patients are not obese. Risk factors in adolescents resemble those of adults.
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Affiliation(s)
- Muhammad Mahajnah
- Child Neurology and Development Center, Hillel-Yaffe Medical Center, Hadera, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Jacob Genizi
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Child Neurology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Hazar Zahalka
- Child Neurology and Development Center, Hillel-Yaffe Medical Center, Hadera, Israel
| | - Ronza Andreus
- Child Neurology and Development Center, Carmel Medical Center & Clalit Health Services, Haifa District, Israel
| | - Nathanel Zelnik
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Child Neurology and Development Center, Carmel Medical Center & Clalit Health Services, Haifa District, Israel
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Wishna A, Hurtig A, Templeton K. Eye Conditions in Women. Gender and the Genome 2020. [DOI: 10.1177/2470289720907105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Changes in vision can have significant impact on health and quality of life. Differences between women and men have been identified in the incidence of several eye conditions. Some of these differences are a result of the greater longevity of women. However, the eye, like other organs, is susceptible to the impacts of inflammation and sex steroids. Conditions, such as thyroid eye disease, optic neuritis, and dry eye disease are related to autoimmune or inflammatory conditions and are, thus, more common among women. Idiopathic intracranial hypertension occurs disproportionately in women of childbearing age; the etiology of this condition appears to be related to both inflammatory and sex hormone fluctuations.
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Affiliation(s)
- Anne Wishna
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Amanda Hurtig
- University of Kansas Medical Center, Kansas City, KS, USA
| | - Kim Templeton
- University of Kansas Medical Center, Kansas City, KS, USA
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Hyde RA, Mocan MC, Sheth U, Kaufman LM. Evaluation of the underlying causes of papilledema in children. Can J Ophthalmol 2019; 54:653-8. [PMID: 31836094 DOI: 10.1016/j.jcjo.2019.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/26/2019] [Accepted: 02/18/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The purpose of this retrospective study was to identify the types and relative frequencies of intracranial disorders in pediatric patients who present with papilledema. DESIGN Retrospective case series. PARTICIPANTS AND METHODS This study was conducted in 2 pediatric ophthalmology clinics, both providing community-based care in a large inner-city urban center in the U.S. Pediatric patients aged between 0 and 16 years diagnosed with papilledema and who had an underlying etiology identified were included in the study. Patient demographic data, ophthalmologic examination findings, and diagnostic work-up results were identified from clinical records. RESULTS The mean age of 38 study patients (19 female, 19 male) was 8.6 ± 4.8 years. Of the 38 patients, 16 (42.1%) had idiopathic intracranial hypertension (IIH) as the underlying cause of the papilledema, 7 (18.4%) had a craniosynostosis disorder, 6 (15.8%) had intracranial tumours, 2 (5.3%) had primary hydrocephalus, and 1 (2.6%) patient each had transverse sinus thrombosis related to sinusitis, hypertensive crisis, subdural hematoma, intracranial abscess, Lyme disease, presumed neurosarcoidosis, and acute disseminated encephalomyelitis. Of the 6 intracranial tumours, 2 (33.3%) presented in the sellar/parasellar region, 2 (33.3%) in the posterior fossa, and 2 (33.3%) were in cortical locations. CONCLUSION Clinicians should have a high index of suspicion for IIH and brain tumours in children presenting with papilledema. Patients with craniosynostosis should have routine eye examinations to monitor for asymptomatic papilledema. Understanding the relative incidence of etiologies for papilledema highlights the urgency of appropriate work-up and the need to consider low-frequency etiologies.
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Abouhashem S, Gad AAM, El-Malkey M, Daoud EA. Idiopathic intracranial hypertension in pediatric and adolescent patients. Egypt J Neurosurg 2019. [DOI: 10.1186/s41984-019-0058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objectives
Pediatric idiopathic intracranial hypertension is a rare condition, but inappropriate diagnosis and management may lead to devastating outcome with loss of vision and lifelong handicap. Dandy criteria are used for diagnosis of idiopathic intracranial hypertension (IIH) in adult, but these criteria cannot be applied in all pediatric patients.
The aim of this study is to evaluate the diagnostic criteria and outcome of management of IIH in pediatric patients.
Methods
Nineteen patients with IIH and age less than 16 years old have been evaluated for the diagnostic criteria and outcome of management. The patients were classified according to the secondary sexual criteria into adolescent IIH and pediatric IIH. Full neurological and ophthalmological evaluation was completed in all patients. The patients were managed and followed up for a mean period of 12 ± 8.6 months at Zagazig University hospitals or Kingdom Hospital in the time period from 2009 to 2018.
Results
Nineteen patients (16 females and 3 males) had been diagnosed and treated with idiopathic intracranial hypertension, their age is between 4 and 15 years, and the patients have been divided into two groups. Group I (pediatric IIH) involved 9 patients (6 females and 3 males), and their age is ranging between 4 and 9 years with mean age 5.56 ± 1.9 years while group II (adolescent IIH) involved 10 patients, all of them are females and their age ranges between 12 and 15 years with mean age 13.5 ± 1.3. Diagnostic criteria of the patients are papilledema, symptoms and signs of intracranial hypertension, and elevated CSF opening pressure with normal MRI. Headache, delayed school performance, and sixth nerve palsy are the most common clinical finding in the patients of group I while headache is the most common presenting symptom in group II. Anemia and otitis media are the most common associated risk factors in group I while obesity and female gender were the most common associated risk factors in group II. The minimum value for opening pressure in group I is 180 mmH2O while the minimum value in group II is 250 mm. 16 patients improved after the first lumbar puncture and drainage of CSF; two patients improved after repeated lumbar puncture while lumbo-peritoneal shunt was inserted for two patients, both of them were in group II. Recurrence was diagnosed in four patients (21%), one of them (11.1%) was in group I while three of them (30%) were in group II.
Conclusion
Pediatric idiopathic intracranial hypertension can be classified into two subtypes: pediatric type and adolescent type according to the secondary sexual criteria.
Modified Dandy criteria can be applied for the diagnosis of adolescent type, but pediatric type is not associated with obesity, has no female predominance, and usually responds to the initial lumbar puncture with a low rate of recurrence.
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Mankad K, Biswas A, Espagnet MCR, Dixon L, Reddy N, Tan AP, Oztekin O, D'Arco F, Shekdar K, Muthusami P, Robertson F, Goergen S, Chong W. Venous pathologies in paediatric neuroradiology: from foetal to adolescent life. Neuroradiology 2020; 62:15-37. [PMID: 31707531 DOI: 10.1007/s00234-019-02294-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023]
Abstract
The interpretation of cerebral venous pathologies in paediatric practice is challenging as there are several normal anatomical variants, and the pathologies are diverse, involving the venous system through direct and indirect mechanisms. This paper aims to provide a comprehensive review of these entities, as their awareness can avoid potential diagnostic pitfalls. We also propose a practical classification system of paediatric cerebral venous pathologies, which will enable more accurate reporting of the neuroimaging findings, as relevant to the underlying pathogenesis of these conditions. The proposed classification system comprises of the following main groups: arterio-venous shunting-related disorders, primary venous malformations and veno-occlusive disorders. A multimodal imaging approach has been included in the relevant subsections, with a brief overview of the modality-specific pitfalls that can also limit interpretation of the neuroimaging. The article also summarises the current literature and international practices in terms of management options and outcomes in specific disease entities.
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Lenck S, Radovanovic I, Nicholson P, Hodaie M, Krings T, Mendes-Pereira V. Idiopathic intracranial hypertension: The veno glymphatic connections. Neurology 2019; 91:515-522. [PMID: 30201744 DOI: 10.1212/wnl.0000000000006166] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/07/2018] [Indexed: 11/15/2022] Open
Abstract
The recent discoveries of the glymphatic and lymphatic systems of the brain have helped advance our understanding of CSF physiology and may allow new insights in the understanding of idiopathic intracranial hypertension (IIH). The clinical and radiologic presentations of IIH appear to be related to congestion of the glymphatic system associated with an overflow of the lymphatic CSF outflow pathway. By revisiting the role of "vascular arachnoid granulations" in the brain, we hypothesize that an initial impairment of the transport of interstitial fluid from the glymphatic system to the venous blood of the dural sinuses may trigger the hydrodynamic cascade of IIH. Furthermore, we speculate that, similar to other water-exchange systems in the brain, a specific subtype of aquaporin is involved in this transport. This theory may eventually help to provide an underlying explanation for IIH and its associated conditions, since in most of them, the expression of several aquaporins is altered.
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Affiliation(s)
- Stéphanie Lenck
- From the Division of Neuroradiology (S.L., P.N., M.H., T.K., V.M.-P.), Department of Medical Imaging, Toronto Western Hospital, University Health Network, Canada; Division of Neuroradiology (S.L.), Groupe Hospitalier Pitié Salpêtrière-Université Paris Sorbonne, France; Division of Neurosurgery (I.R., M.H., V.M.-P.), Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto; and Krembil Neuroscience Center (I.R.), University Health Network, Toronto, Canada.
| | - Ivan Radovanovic
- From the Division of Neuroradiology (S.L., P.N., M.H., T.K., V.M.-P.), Department of Medical Imaging, Toronto Western Hospital, University Health Network, Canada; Division of Neuroradiology (S.L.), Groupe Hospitalier Pitié Salpêtrière-Université Paris Sorbonne, France; Division of Neurosurgery (I.R., M.H., V.M.-P.), Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto; and Krembil Neuroscience Center (I.R.), University Health Network, Toronto, Canada
| | - Patrick Nicholson
- From the Division of Neuroradiology (S.L., P.N., M.H., T.K., V.M.-P.), Department of Medical Imaging, Toronto Western Hospital, University Health Network, Canada; Division of Neuroradiology (S.L.), Groupe Hospitalier Pitié Salpêtrière-Université Paris Sorbonne, France; Division of Neurosurgery (I.R., M.H., V.M.-P.), Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto; and Krembil Neuroscience Center (I.R.), University Health Network, Toronto, Canada
| | - Mojgan Hodaie
- From the Division of Neuroradiology (S.L., P.N., M.H., T.K., V.M.-P.), Department of Medical Imaging, Toronto Western Hospital, University Health Network, Canada; Division of Neuroradiology (S.L.), Groupe Hospitalier Pitié Salpêtrière-Université Paris Sorbonne, France; Division of Neurosurgery (I.R., M.H., V.M.-P.), Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto; and Krembil Neuroscience Center (I.R.), University Health Network, Toronto, Canada
| | - Timo Krings
- From the Division of Neuroradiology (S.L., P.N., M.H., T.K., V.M.-P.), Department of Medical Imaging, Toronto Western Hospital, University Health Network, Canada; Division of Neuroradiology (S.L.), Groupe Hospitalier Pitié Salpêtrière-Université Paris Sorbonne, France; Division of Neurosurgery (I.R., M.H., V.M.-P.), Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto; and Krembil Neuroscience Center (I.R.), University Health Network, Toronto, Canada
| | - Vitor Mendes-Pereira
- From the Division of Neuroradiology (S.L., P.N., M.H., T.K., V.M.-P.), Department of Medical Imaging, Toronto Western Hospital, University Health Network, Canada; Division of Neuroradiology (S.L.), Groupe Hospitalier Pitié Salpêtrière-Université Paris Sorbonne, France; Division of Neurosurgery (I.R., M.H., V.M.-P.), Department of Surgery, Toronto Western Hospital, University Health Network, University of Toronto; and Krembil Neuroscience Center (I.R.), University Health Network, Toronto, Canada
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Türay S, Kabakuş N, Hanci F, Tunçlar A, Hizal M. Cause or Consequence: The Relationship Between Cerebral Venous Thrombosis and Idiopathic Intracranial Hypertension. Neurologist 2019; 24:155-60. [DOI: 10.1097/nrl.0000000000000242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
PURPOSE OF REVIEW Pseudotumor cerebri syndrome (PTCS) may affect both children and adults; however, the risk factors and clinical presentation vary greatly between these populations. This review aims to highlight the entity of PTCS in children and the unique considerations in this population; review the epidemiology and demographics; discuss the clinical presentation, revised diagnostic criteria, and approach to evaluation; review management strategies; and discuss the prognosis and long-term outcomes in children with PTCS. RECENT FINDINGS Clinical presentation can be variable in children and may be less obvious than in their adult counterparts. Papilledema can also be challenging to diagnose in this population. The upper limits for opening pressure on lumbar puncture differ in children, with a cut-off of 25 cm H20 (or 28 cm H2O in a sedated or obese child). Morbidity related to visual loss, pain and reduced quality of life lends urgency towards accurately identifying, evaluating and managing children with PTCS. There are no randomised controlled studies to allow for evidence-based recommendations for the management of PTCS in children. Further studies are needed to clarify and consolidate management approaches in this population.
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Affiliation(s)
- Rebecca Barmherzig
- Division of Neurology, Women's College Hospital Centre for Headache, University of Toronto, Toronto, Canada.,Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Christina L Szperka
- Pediatric Headache Program, Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, CTRB 10019 3501 Civic Center Blvd., Philadelphia, PA, 19104, USA.
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Agraz D, Morgan LA, Fouzdar Jain S, Suh DW. Clinical features of pediatric idiopathic intracranial hypertension. Clin Ophthalmol 2019; 13:881-886. [PMID: 31213758 PMCID: PMC6538838 DOI: 10.2147/opth.s183087] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/28/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction: Adult idiopathic intracranial hypertension (IIH) is often linked to obesity, however, causes of IIH in children are not well understood. This project identifies potential risk factors and features of pediatric IIH. Methods: This study consisted of a retrospective chart review of patients ages 5–17 years who were seen at a tertiary care children’s hospital and diagnosed with IIH. Diagnostic criteria included the presence of papilledema, normal neurological exam, normal neuroimaging, normal cerebrospinal fluid composition, and an opening pressure of a lumbar puncture >28 mmHg. Results: Of the 26 cases of IIH, 19 met all diagnostic criteria for this study, while seven patients were probable IIH, as they lacked papilledema. Intracranial pressure ranged from 28 to 66 mmHg, with a mean of 40.23 mmHg (±10.74). Overall, 50.0% (95% CI: 29.9–70.1%) of IIH patients were obese, with patients 12 years of age and younger exhibiting an overall obesity rate of 30.7% and patients 13 years of age and older having an obesity rate of 69.2%. The overall allergy rate in this IIH patient population was 46.2% (95% CI: 26.6–66.6%). Conclusion: Obesity appears to have no association with IIH in younger cases, but it is a more common feature in older children. An autoimmune component may play a role in pediatric IIH, given the high rate of atopy observed in this pediatric IIH patient cohort. Because a diagnosis of IIH can have an absence of optic nerve edema, taking a detailed history and performing a thorough examination are keys to diagnosing IIH in the pediatric population.
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Affiliation(s)
- Daniel Agraz
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Linda A Morgan
- Department of Pediatric Ophthalmology, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Samiksha Fouzdar Jain
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pediatric Ophthalmology, Children's Hospital and Medical Center, Omaha, NE, USA
| | - Donny W Suh
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Pediatric Ophthalmology, Children's Hospital and Medical Center, Omaha, NE, USA
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Bhalla S, Nickel NE, Mutchnick I, Ziegler C, Sowell M. Demographics, clinical features, and response to conventional treatments in pediatric Pseudotumor Cerebri syndrome: a single-center experience. Childs Nerv Syst 2019; 35:991-998. [PMID: 31025099 DOI: 10.1007/s00381-019-04150-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/03/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The goal of this study was to better understand pediatric Pseudotumor Cerebri syndrome, and its relationship to age, obesity, and other medical conditions; and to evaluate response to conventional treatments. METHODS A retrospective chart review was performed on consecutive patients who were diagnosed with PTCS between January 1, 2007, and July 31, 2014. A total of 78 patients were included in this study: 54 female (69.3%) and 24 male (30.7%). Variables including age, sex, body mass index, concomitant medical conditions, secondary causes, associated symptoms, physical exam findings, imaging results, recurrence of symptoms, and treatment modalities were analyzed. Patients were grouped into "pre-kindergarten," "elementary," and "adolescent" based on their age; and weight categories of underweight, normal weight, overweight, moderately, and severely obese. RESULTS Mean age of symptom onset was 11.92 ± 4.09 years. Elementary and adolescent age patients were more likely to be overweight, moderately obese, and severely obese, while this finding was not found for patients in pre-kindergarten group. Headache (83.3%) and visual disturbances (48.7%) were the most common presenting complaints. Asthma (16.6%) was the most common associated concomitant medical condition. Medical management resulted in resolution in 84% of population, 15% required surgical interventions, and the recurrence rate was found to be 20.5%. There was a statistically significant trend in success with medical management in younger patients (p = 0.04), while medically refractory PTCS was seen in adolescent females. Recurrence of PTCS had a linear trend with increased occurrence in adolescent age group with higher BMI. Asthma was observed to be frequently associated with PTCS in our cohort. Obesity is strongly associated with PTCS, not only in the adolescent group but also in the younger elementary age group. Treatment remains similar to management in the adults with a good response (84%) to medical management and a low relapse rate.
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Affiliation(s)
- Sonam Bhalla
- Division of Child Neurology, Department of Neurology, Columbia University Medical Center, New York, NY, USA.
| | - Noura Estephane Nickel
- Department of Pediatrics, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Ian Mutchnick
- Division of Pediatric Neurosurgery, Norton Neuroscience Institute, Norton Children's Hospital and University of Louisville School of Medicine, Louisville, KY, USA
| | - Craig Ziegler
- University of Louisville Office of Graduate Medical Education, Louisville, KY, USA
| | - Michael Sowell
- Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine, Louisville, KY, USA
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Mosquera Gorostidi A, Iridoy Zulet M, Azcona Ganuza G, Gembero Esarte E, Yoldi Petri M, Aguilera Albesa S. Pseudotumour cerebri in children: aetiology, clinical features, and progression. Neurología (English Edition) 2019. [DOI: 10.1016/j.nrleng.2018.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Mosquera Gorostidi A, Iridoy Zulet M, Azcona Ganuza G, Gembero Esarte E, Yoldi Petri M, Aguilera Albesa S. Seudotumor cerebri en niños: etiología, características clínicas y evolución. Neurologia 2019; 34:89-97. [DOI: 10.1016/j.nrl.2016.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 11/08/2016] [Accepted: 11/12/2016] [Indexed: 11/30/2022] Open
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Delaney AC, Velarde A, Harper MB, Lebel A, Landschaft A, Monuteaux M, Heidary G, Kimia AA. Predictors of Primary Intracranial Hypertension in Children Using a Newly Suggested Opening Pressure Cutoff of 280 mm H 2O. Pediatr Neurol 2019; 91:27-33. [PMID: 30573329 DOI: 10.1016/j.pediatrneurol.2018.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/19/2018] [Accepted: 09/26/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES We assessed the clinical characteristics of primary intracranial hypertension (PIH) in children using a newly recommended threshold for cerebrospinal fluid opening pressure (280 mm H2O). METHOD Cross-sectional study of patients age ≤21 years who had a lumbar puncture done for evaluation of PIH. Patients were excluded if lumbar puncture was done for a suspected infection, seizure, mental status changes, multiple sclerosis, or Guillain-Barre syndrome. Cases were identified using a text-search module followed by manual review. We performed χ2 analysis for categorical data and Mann-Whitney U test for continuous data, followed by a binary logistic regression. RESULTS We identified 374 patients of whom 67% were female, median age was 13 years interquartile range (11 to 16 years), and admission rate was 24%. Using an opening pressure cutoff of 250 mm H2O, 127 patients (34%) were identified as having PIH, whereas using the new cutoff 105 patients (28%) met PIH criteria. Predictors for PIH included optic disc edema or sixth nerve palsy using both old, odds ratio (OR) 7.6 (4.3, 13.5), and new cutoffs, OR 9.7 (95% confidence interval 5.1, 18.5). Headache duration ≤61 days is predictive of PIH using the new cutoff OR 4.1 (95% confidence interval 1.3, 12.8). A model is presented which stratifies patients into groups with low (7%), medium (18%), and high (greater than 42%) risk of PIH. CONCLUSIONS A higher cerebrospinal fluid opening pressure threshold in the criteria of PIH is associated with PIH patients with a different symptom profile. Children with optic disc edema, bulging fontanel or sixth nerve palsy, are at increased risk for PIH.
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Affiliation(s)
- Atima C Delaney
- Department of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Aynslee Velarde
- Department of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Marvin B Harper
- Department of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Alyssa Lebel
- Department of Anesthesia/Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Assaf Landschaft
- Department of IT, Boston Children's Hospital, Boston, Massachusetts
| | - Michael Monuteaux
- Department of Biostat, Boston Children's Hospital, Boston, Massachusetts
| | - Gena Heidary
- Department of Neuro-Ophthalmology, Boston Children's Hospital, Boston, Massachusetts
| | - Amir A Kimia
- Department of Emergency Medicine, Department of Informatics, Boston Children's Hospital, Boston, Massachusetts.
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Soin P, Afzaal UM, Sharma P, Kochar PS. Isolated spontaneous cerebrospinal fluid rhinorrhoea as a rare presentation of idiopathic intracranial hypertension: Case reports with comprehensive review of literature. Indian J Radiol Imaging 2019; 28:406-411. [PMID: 30662200 PMCID: PMC6319102 DOI: 10.4103/ijri.ijri_228_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Isolated cerebrospinal fluid (CSF) rhinorrhoea as a sole presenting symptom of idiopathic intracranial hypertension (IIH) is extremely rare. IIH typically presents with headache, pulsatile tinnitus, dizziness, nausea, vomiting, and visual disturbance. We report two cases which presented with acute onset spontaneous CSF rhinorrhoea without any other symptom. In addition, we discuss in detail imaging features of IIH with review of its literature.
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Affiliation(s)
- Priti Soin
- Department of Pathology and Laboratory Medicine, Weil Cornell College of Medicine, New York, USA
| | - Umer M Afzaal
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, USA
| | - Pranav Sharma
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, USA
| | - Puneet S Kochar
- Department of Radiology, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, USA
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Zhou B, Yim C, Chawla S. Headache in an Obese Adolescent Male: A Nonclassical Presentation of an Uncommon Disease. Glob Pediatr Health 2018; 5:2333794X18785550. [PMID: 30014011 PMCID: PMC6042010 DOI: 10.1177/2333794x18785550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/03/2017] [Indexed: 12/02/2022] Open
Abstract
Background. Idiopathic intracranial hypertension (IIH), also known as pseudotumor cerebri, is a diagnosis of exclusion in the clinical scenario of increased intracranial pressure without an identifiable cause. This case report provides a brief review of current literature on IIH, important differential considerations to rule out prior to diagnosis, and relevant imaging findings of IIH. Case Presentation. An 18-year-old male presenting with headache and blurry vision was found to have signs of increased intracranial pressure on imaging without other abnormalities to explain the cause, suggesting IIH as a diagnosis. Conclusion. IIH is classically seen in overweight females of childbearing age but should be considered in all obese patients, including the pediatric population given the increasing rate of childhood obesity.
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Affiliation(s)
- Bill Zhou
- University of California Los Angeles, CA, USA
| | - Catherine Yim
- University of California Los Angeles, CA, USA.,Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Soni Chawla
- University of California Los Angeles, CA, USA.,Olive View-UCLA Medical Center, Sylmar, CA, USA
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Lee EB, Edelman FS, Stafstrom CE. Evidence of Diplopia in Children's Headache Drawings Helps to Differentiate Pseudotumor Cerebri From Migraine. Pediatr Neurol 2018; 79:40-4. [PMID: 29413638 DOI: 10.1016/j.pediatrneurol.2017.10.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/17/2017] [Accepted: 10/29/2017] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study aimed to determine whether children's headache drawings can distinguish between pseudotumor cerebri and migraine. BACKGROUND Headache features associated with pseudotumor cerebri (pseudotumor; idiopathic intracranial hypertension) are nonspecific and are difficult to distinguish clinically from migraines. Children's headache drawings have a high predictive value for migraine versus nonmigraine headaches. We hypothesized that drawings could help to differentiate pediatric headaches due to pseudotumor cerebri from those associated with migraines. METHODS Children aged six to 18 years old attending university hospital pediatric neurology clinics were asked to draw a picture of how their headache feels. From our database of children's headache drawings, pictures by children with clinically diagnosed pseudotumor were compared with migraine drawings. RESULTS Headache drawings of 21 children (16 females) with pseudotumor were compared with those of 518 children with migraine. Pseudotumor drawings depicted a variety of symptoms including pounding pain (n = 11), pressure-like pain (n = 3), photophobia (3), dizziness (1), and recumbency (1). Severe pain indicators included hammers, bombs, anvil, and vise grip. Positive visual phenomena included scintillations, scotomata, or blurring (n = 8). Negative visual phenomena included field defects (n = 2). Pseudotumor drawings were similar to migraine drawings except that 6 of 21 pseudotumor drawings (28.6%) depicted diplopia (crossed eyes, double images), whereas only three of 518 migraine drawings (0.6%) depicted diplopia (P < 0.000001). CONCLUSIONS Diplopia was depicted in a significantly higher percentage of pseudotumor drawings than migraine drawings. In all other respects, headache drawings by children with pseudotumor cerebri were similar to those drawn by children with migraine.
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Tovia E, Reif S, Oren A, Mitelpunkt A, Fattal-valevski A. Treatment Response in Pediatric Patients With Pseudotumor Cerebri Syndrome. J Neuroophthalmol 2017; 37:393-7. [DOI: 10.1097/wno.0000000000000516] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hoang KB, Hooten KG, Muh CR. Shunt freedom and clinical resolution of idiopathic intracranial hypertension after bariatric surgery in the pediatric population: report of 3 cases. J Neurosurg Pediatr 2017; 20:511-516. [PMID: 28960170 DOI: 10.3171/2017.6.peds17145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Idiopathic intracranial hypertension (IIH), formerly known as pseudotumor cerebri, is a disease of elevated intracranial pressure that is thought to develop due to impaired CSF absorption related to elevated venous sinus pressure in the setting of increased intraabdominal and thoracic pressures. Symptoms can be disabling and, if left untreated, can lead to permanent visual loss. Previous treatments directed toward vision preservation include CSF diversion through shunting and optic nerve sheath fenestration. Recently, attention has been turned toward surgical weight loss strategies as an alternative to shunt treatment. The authors present a report of 3 patients with adolescent-onset IIH that was treated at the authors' institution (Duke University) in whom bariatric surgery was pursued successfully. The patients had previously undergone CSF shunting at ages 12, 15, and 23 years. They were shunt dependent for a collective average of 3.3 years prior to bariatriwc surgery. All patients reported "low-pressure" or postural headaches after bariatric surgery that correlated with dramatic reduction in their weight. Two of the 3 patients had their shunts removed and continued to be shunt free 1.5 years later at last follow-up; the third patient remained shunt dependent with the pressure set at 200 mm H2O. Given the significant complications inherent to multiple shunt revisions, earlier intervention for weight loss, including bariatric surgery, in these patients might have prevented complications and the associated health care burden. The authors recommend a multidisciplinary approach for IIH treatment with early consideration for weight loss interventions in select patients.
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Affiliation(s)
- Kimberly B Hoang
- 1Department of Neurosurgery, Duke University, Durham, North Carolina; and
| | - Kristopher G Hooten
- 1Department of Neurosurgery, Duke University, Durham, North Carolina; and.,2Department of Neurosurgery, University of Florida, Gainesville, Florida
| | - Carrie R Muh
- 1Department of Neurosurgery, Duke University, Durham, North Carolina; and
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Abstract
Idiopathic intracranial hypertension, otherwise known as primary pseudotumor cerebri syndrome (PTCS), most frequently occurs in obese women of childbearing age. However, children may be affected as well. This review will address recent findings regarding demographics, diagnosis, and treatment of pediatric PTCS. Prepubertal children with primary PTCS have an equal sex distribution and less frequent obesity compared with adult patients. However, female gender and obesity are risk factors for primary PTCS in postpubertal children. Compared with adults, children with PTCS more frequently present with ocular motility deficits and more often have associated medical conditions that increase the risk of developing PTCS. Visual field testing may be unreliable, and the optimal modality to monitor visual function is unknown. MRI shows signs of elevated intracranial pressure (ICP) in children with PTCS similar to that of adults. It has now been established that elevated ICP in children ≤18 years old is greater than 25 cm H20 in nonobese, nonsedated children, and greater than 28 cm H2O in the remainder. Optical coherence tomography (OCT) may be used to distinguish pseudopapilledema from papilledema, monitor response to treatment in preverbal children, and identify patients with PTCS at risk for permanent visual loss. However, the precise role of OCT in the management of pediatric PTCS remains to be determined.
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Monge Galindo L, Fernando Martínez R, Fuertes Rodrigo C, Fustero de Miguel D, Pueyo Royo V, García Iñiguez JP, López-Pisón J, Peña-Segura JL. Idiopathic intracranial hypertension: Experience over 25 years and a management protocol. Anales de Pediatría (English Edition) 2017. [DOI: 10.1016/j.anpede.2016.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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