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Asal N, Bayar Muluk N, Özdemir A, Say B. Evaluation of peripheral and central olfactory regions by MRI in patients with idiopathic intracranial hypertension. Neurol Res 2023; 45:346-353. [PMID: 36373831 DOI: 10.1080/01616412.2022.2146261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We investigated the peripheral and central smell regions in patients with idiopathic intracranial hypertension (IIH) by cranial MRI. METHODS In this retrospective study, cranial MRI images of 43 adult patients with IIH (Group 1) and 43 healthy adults without IIH (Group 2) were included. In both groups, peripheral [Olfactory bulb (OB) volume and Olfactory sulcus (OS) depth] and central smell regions (insular gyrus and corpus amygdala area, and thalamus volume) were measured in cranial MRI. RESULTS Bilateral OB volume and insular gyrus area, and right corpus amygdala and thalamus volumes of the IIH group were significantly lower than those of the control group (p < 0.05). In the IIH group, OB volume of the right side was significantly lower, and insular gyrus area of the right side was significantly higher than those of the left side (p < 0.05). In the IIH group, there were positive correlations between OB volumes; OS depths; insular gyrus areas; corpus amygdala areas; and thalamus volumes bilaterally (p < 0.05). In older patients, right OS depth and right corpus amygdala area decreased (p < 0.05). CONCLUSION In conclusion, IIH may be related to olfactory impairment. Cranial MRI images showed a decrease in peripheral (OB volume) and central (insular gyrus and corpus amygdala area and thalamus volume) smell regions. To prevent olfactory impairment in IIH patients, treatment should be done in IIH patients to decrease intracranial pressure. It is very important to prevent the circulation of CSF with increased pressure between the sheets of the olfactory nerve in IIH patients.
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Affiliation(s)
- Neşe Asal
- Faculty of Medicine, Radiology Department, Kırıkkale University, Kırıkkale, Turkey
| | - Nuray Bayar Muluk
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
| | - Adnan Özdemir
- Faculty of Medicine, Radiology Department, Kırıkkale University, Kırıkkale, Turkey
| | - Bahar Say
- Faculty of Medicine, Neurology Department, Kırıkkale University, Kırıkkale, Turkey
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2
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Alqahtani YAM, Aljabri MF, Oshi MAM, Kamal NM, Elhaj W, Abosabie SA, Abosabie SA. An Unusual Case of Headache in a Child: Idiopathic Intracranial Hypertension with Diagnostic Challenge. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231158509. [PMID: 36874375 PMCID: PMC9974625 DOI: 10.1177/11795476231158509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/02/2023] [Indexed: 03/06/2023]
Abstract
Introduction In children, idiopathic intracranial hypertension (IIH) is relatively uncommon. It is characterized by an increase in intracranial pressure, in the absence of evidence of underlying brain disease, structural abnormalities, hydrocephalus, or abnormal meningeal improvement. However, very rarely it can occur without papilledema, even though it is the most recognizable clinical sign. Due to this, a delay in diagnosis can lead to severe visual impairments. Case presentation We describe a patient with a chronic headache but no papilledema. His neurological and systemic examinations were otherwise unremarkable. A lumbar puncture revealed a high opening pressure of 450 mmH2O and normal cerebrospinal fluid (CSF) parameters. Magnetic resonance imaging of the brain revealed only tortuous optic nerves, no parenchymal lesions, and no evidence of venous sinus thrombosis. He required acetazolamide treatment. Our patient's symptoms improved significantly in 2 months with medical treatment, weight loss, and exercise, with no development of papilledema. Conclusion There is a wide range of clinical manifestations of IIH, making it difficult to decide when to begin treatment.
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Affiliation(s)
- Youssef Ali M Alqahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mohammed Fahad Aljabri
- Neurology Division, Department of Pediatrics, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | | | - Naglaa M Kamal
- Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Waleed Elhaj
- Neurology Division, Department of Pediatrics, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Sara A Abosabie
- Faculty of Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Salma As Abosabie
- Faculty of Medicine, Julius-Maximilians-Universität Würzburg, Bavaria, Germany
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3
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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] [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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4
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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] [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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5
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Nguyen J, Joseph D. Graves' disease in an adolescent presenting with increased intracranial pressure and bilateral papilledema. Endocrinol Diabetes Metab Case Rep 2022; 2022:22-0240. [PMID: 35466085 PMCID: PMC9066564 DOI: 10.1530/edm-22-0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/24/2022] Open
Abstract
Summary Increased intracranial pressure (ICP) can present with symptoms of headache, vomiting, visual changes, and tinnitus. Papilledema may be seen on physical exam. Thyroid disease has been a rare secondary cause of increased ICP. We present a 16-year-old female who had a worsening headache for 6 months. She was found to have signs, symptoms, physical exam findings, and diagnostic studies consistent with both increased ICP and previously undiagnosed Graves' disease. The patient was treated with a 19-month course of methimazole 40 mg daily. Her headache and papilledema resolved shortly after medication initiation. The timeline of symptoms and resolution of her increased ICP symptoms with treatment of Graves' disease suggests that hyperthyroidism was the underlying cause of her increased ICP. Clinicians should consider Graves' disease as the etiology in pediatric patients presenting with signs and symptoms of increased ICP with papilledema. Learning points Symptoms of increased intracranial pressure (ICP) include headache, vomiting, transient visual changes, and tinnitus. Secondary causes of increased ICP should be considered in males, young children, older patients, and those not overweight. Clinicians should consider Graves' disease as the etiology in pediatric patients presenting with signs and symptoms of increased ICP with papilledema. They should assess for orbitopathy and thyromegaly and inquire about symptoms that would be indicative of hyperthyroidism.
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Affiliation(s)
- Jay Nguyen
- Lincoln Memorial University-DeBusk College of Osteopathic Medicine, Harrogate, Tennessee, USA
| | - Dennis Joseph
- Endocrinology Center of Lake Cumberland, Somerset, Kentucky, USA
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6
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Rohit W, Rajesh A, Mridula R, Jabeen SA. Idiopathic Intracranial Hypertension - Challenges and Pearls. Neurol India 2022; 69:S434-S442. [PMID: 35103000 DOI: 10.4103/0028-3886.332276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Idiopathic intracranial hypertension (IIH) is defined as a syndrome of raised intracranial pressure with normal imaging of the brain and cerebrospinal fluid (CSF) composition. There is a rising incidence and prevalence of this disease related to the increased prevalence of obesity. It typically affects women of working age, and headache is the predominant morbidity in over 90%. The disease is also more prevalent in young males. There are many controversies and myths that surround IIH. There are currently few treatment options for IIH, management is typically medical with those experiencing progressive visual loss undergoing surgical procedures. Weight loss and venous sinus stenting are a few therapies directed at the etiology.
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Affiliation(s)
- Wadikhaye Rohit
- RVM Institute of Medical Science and Research Centre, Hyderabad, Telangana, India
| | - Alugolu Rajesh
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Rukmini Mridula
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Shaik A Jabeen
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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7
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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] [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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8
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Chen BS, Newman NJ, Biousse V. Atypical presentations of idiopathic intracranial hypertension. Taiwan J Ophthalmol 2021; 11:25-38. [PMID: 33767953 PMCID: PMC7971435 DOI: 10.4103/tjo.tjo_69_20] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 09/11/2020] [Indexed: 11/05/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH) is a disorder of unknown etiology that results in isolated raised intracranial pressure. Classic symptoms and signs of IIH include headache, papilledema, diplopia from sixth nerve palsy and divergence insufficiency, and pulsatile tinnitus. Atypical presentations include: (1) highly asymmetric or even unilateral papilledema, and IIH without papilledema; (2) ocular motor disturbances from third nerve palsy, fourth nerve palsy, internuclear ophthalmoplegia, diffuse ophthalmoplegia, and skew deviation; (3) olfactory dysfunction; (4) trigeminal nerve dysfunction; (5) facial nerve dysfunction; (6) hearing loss and vestibular dysfunction; (7) lower cranial nerve dysfunction including deviated uvula, torticollis, and tongue weakness; (8) spontaneous skull base cerebrospinal fluid leak; and (9) seizures. Although atypical findings should raise a red flag and prompt further investigation for an alternative etiology, clinicians should be familiar with these unusual presentations.
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Affiliation(s)
- Benson S. Chen
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Nancy J. Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, United States
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9
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Lee HC, Park CK. Pseudopapilledema Combined with Idiopathic Papilledema in a Child Receiving Growth Hormone Treatment. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.12.1548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Alboudi A, Johnson EC. Unusual presentation of idiopathic intracranial hypertension. BMJ Case Rep 2020; 13:13/5/e234741. [PMID: 32475825 DOI: 10.1136/bcr-2020-234741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Idiopathic intracranial hypertension typically presents with holocephalic headache associated with nausea, vomiting and bilateral papilledema. Involvement of the sixth cranial nerve is relatively common. The involvement of other cranial nerves, however, is rare in this disorder. We describe a patient with idiopathic intracranial hypertension who presented with episodic unilateral retro-orbital pain and multiple cranial nerve abnormalities without papilledema. Imaging studies excluded alternate diagnoses, and the immediate resolution of symptoms after lumbar puncture confirmed that these symptoms were due to intracranial hypertension. Atypical presentations of such a disabling yet treatable disorder is very important to recognise and address.
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Affiliation(s)
- Ayman Alboudi
- Neurology, Michigan State University, East Lansing, Michigan, USA .,Department of Neurology, Mercy Health Saint Mary's, Grand Rapids, Michigan, USA
| | - Emily C Johnson
- Mercy Health Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, Michigan, USA
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11
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Abouhashem S, Gad AAM, El-Malkey M, Daoud EA. Idiopathic intracranial hypertension in pediatric and adolescent patients. EGYPTIAN JOURNAL OF NEUROSURGERY 2019. [DOI: 10.1186/s41984-019-0058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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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12
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Boles S, Martinez-Rios C, Tibussek D, Pohl D. Infantile Idiopathic Intracranial Hypertension: A Case Study and Review of the Literature. J Child Neurol 2019; 34:806-814. [PMID: 31309848 DOI: 10.1177/0883073819860393] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Idiopathic intracranial hypertension, or pseudotumor cerebri, is an increase in cerebrospinal fluid pressure of unknown etiology. It is mostly seen in adults, less frequently in adolescents, rarely in younger children. Only 5 infants meeting idiopathic intracranial hypertension criteria have been mentioned in the literature. We report a case of a previously healthy 9-month-old boy who presented with irritability, decreased appetite, and a bulging fontanelle. Computed tomography (CT) head imaging and cerebrospinal fluid studies revealed normal results. The patient's symptoms transiently resolved after the initial lumbar puncture, but 11 days later, his fontanelle bulged again. A second lumbar puncture revealed an elevated opening pressure of 35 cmH2O and led to a diagnosis of idiopathic intracranial hypertension in accordance with the modified Dandy Criteria. Treatment with acetazolamide at a dose of 25 mg/kg/d was initiated and the patient remained symptom-free for 6 weeks, followed by another relapse. His acetazolamide dose was increased to 37 mg/kg/d, with no further relapses to date. A diagnosis of idiopathic intracranial hypertension is challenging in infants, because the patients cannot yet verbalize typical idiopathic intracranial hypertension-related symptoms such as positional headaches, diplopia, or pulsatile tinnitus. Furthermore, it is more difficult to assess papilledema in that age group. If undetected and untreated, idiopathic intracranial hypertension may result in permanent visual deficits. Little is known about idiopathic intracranial hypertension in infants, and age-specific treatment guidelines are lacking. We discuss this rare case of infantile idiopathic intracranial hypertension and provide a review of the literature, including an overview of disease characteristics and outcomes of idiopathic intracranial hypertension in this very young age group.
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Affiliation(s)
- Sama Boles
- University of Ottawa, Ottawa, Ontario, Canada
| | - Claudia Martinez-Rios
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Tibussek
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Daniela Pohl
- Division of Neurology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
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13
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Hamedani AG, Witonsky KFR, Cosico M, Rennie R, Xiao R, Sheldon CA, Paley GL, McCormack SE, Liu GW, Friedman DI, Liu GT, Szperka CL. Headache Characteristics in Children With Pseudotumor Cerebri Syndrome, Elevated Opening Pressure Without Papilledema, and Normal Opening Pressure: A Retrospective Cohort Study. Headache 2018; 58:1339-1346. [PMID: 30137653 DOI: 10.1111/head.13362] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/22/2016] [Accepted: 05/18/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Certain headache characteristics and associated symptoms are commonly attributed to increased intracranial pressure, but they have not been systematically studied among children in the context of revised diagnostic criteria for pseudotumor cerebri syndrome (PTCS). METHODS We performed a retrospective cohort study of patients treated for suspected or confirmed PTCS. Charts were reviewed for PTCS and headache diagnostic criteria and associated characteristics. Chi-squared or Fisher's exact tests were used to compare the frequency of headache characteristics between groups. RESULTS One hundred and twenty-seven individuals were identified: 61 had definite PTCS, 10 had probable PTCS, 31 had elevated opening pressure (OP) without papilledema, and 25 had normal OP without papilledema. Eleven children had no headache (6 with definite PTCS, 5 with probable PTCS). Headache pattern was episodic in 49% (95% CI: 34-64%) of those with definite PTCS, 18% (95% CI 6-37%) of those with elevated OP without papilledema, and 16% (5-36%) of those with normal OP without papilledema. Headache location was more likely to involve the head along with neck or shoulders in those with definite PTCS compared with elevated OP without papilledema (OR = 7.2, 95% CI: 1.9-27.6) and normal OP (OR = 4.5, 95% CI: 1.3-15.6) groups. DISCUSSION While missing data and small cohort size are limitations, this study suggests that headache in PTCS is more likely to involve the head along with neck/shoulders, and that headache in PTCS may be episodic or constant. Headache is occasionally absent in PTCS.
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Affiliation(s)
- Ali G Hamedani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kailyn F R Witonsky
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mahgenn Cosico
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robert Rennie
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Riu Xiao
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Claire A Sheldon
- Neuro-Ophthalmology Service, Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Ophthalmology & Visual Sciences, University of British Columbia, Vancouver, CA, Canada
| | - Grace L Paley
- Neuro-Ophthalmology Service, Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shana E McCormack
- Division of Endocrinology & Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Geraldine W Liu
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Deborah I Friedman
- Department of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Grant T Liu
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Neuro-Ophthalmology Service, Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christina L Szperka
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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15
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Pseudotumor Cerebri in a Child with Idiopathic Growth Hormone Insufficiency Two Months after Initiation of Recombinant Human Growth Hormone Treatment. Case Rep Ophthalmol Med 2016; 2016:4756894. [PMID: 26966604 PMCID: PMC4757697 DOI: 10.1155/2016/4756894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/17/2016] [Accepted: 01/20/2016] [Indexed: 11/29/2022] Open
Abstract
Purpose. To report a rare case of pseudotumor cerebri (PTC) in a child two months after receiving treatment with recombinant human growth hormone (rhGH) and to emphasize the need of close collaboration between ophthalmologists and pediatric endocrinologists in monitoring children receiving rhGH. Methods. A 12-year-old boy with congenital hypothyroidism started treatment with rhGH on a dose of 1,5 mg/daily IM (4.5 IU daily). Eight weeks later, he was complaining of severe headache without any other accompanying symptoms. The child was further investigated with computed tomography scan and lumbar puncture. Results. Computed tomography scan showed normal ventricular size and lumbar puncture revealed an elevated opening pressure of 360 mm H2O. RhGH was discontinued and acetazolamide 250 mg per os twice daily was initiated. Eight weeks later, the papilledema was resolved. Conclusions. There appears to be a causal relationship between the initiation of treatment with rhGH and the development of PTC. All children receiving rhGH should have a complete ophthalmological examination if they report headache or visual disturbances shortly after the treatment. Discontinuation of rhGH and initiation of treatment with acetazolamide may be needed and regular follow-up examinations by an ophthalmologist should be recommended.
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Masri A, Jaafar A, Noman R, Gharaibeh A, Ababneh OH. Intracranial Hypertension in Children: Etiologies, Clinical Features, and Outcome. J Child Neurol 2015; 30:1562-8. [PMID: 25762586 DOI: 10.1177/0883073815574332] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/27/2015] [Indexed: 11/15/2022]
Abstract
This retrospective study aimed to describe the clinical presentations, possible causes, and outcomes of children with idiopathic intracranial hypertension who presented to the authors' clinic. The mean age at onset of symptoms in the authors' cohort of 19 children was 6 years (range: 7 months to 12 years). Most patients (90%) were under 11 years old and (84.2%) symptomatic. The probable cause was identified in 7/19 (37.0%) patients. The most common cause was vitamin D deficiency (26.3%). Other associated probably coincidental comorbidities included sinusitis (5/19, 26.3%), hypophosphatasia (1/19), Pyle disease (1/19), and measles vaccine (1/19). Apart from 2 patients who required lumboperitoneal shunt, the cerebrospinal fluid pressure returned to normal in all patients within a period of 6 weeks to 1 year (average, 5 months). Of those who followed up with the authors' ophthalmologist, 30.7% developed optic atrophy or pallor; 75% of these patients had previous ocular comorbidities.
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Affiliation(s)
- Amira Masri
- Faculty of Medicine, Division of Child Neurology, Department of Pediatrics, University of Jordan, Amman, Jordan
| | - Amani Jaafar
- Faculty of Medicine, Department of Pediatrics, University of Jordan, Amman, Jordan
| | - Rasha Noman
- Faculty of Medicine, Resident Department of Pediatrics, University of Jordan, Amman, Jordan
| | - Almutez Gharaibeh
- Faculty of Medicine, Department of Ophthalmology, University of Jordan and Jordan University Hospital, Amman, Jordan
| | - Osama H Ababneh
- Faculty of Medicine, Department of Ophthalmology, University of Jordan and Jordan University Hospital, Amman, Jordan
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Oudenhoven MD, Kinney MA, McShane DB, Burkhart CN, Morrell DS. Adverse effects of acne medications: recognition and management. Am J Clin Dermatol 2015; 16:231-242. [PMID: 25896771 DOI: 10.1007/s40257-015-0127-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Acne vulgaris is a very common chronic inflammatory disease of the skin. The clinical features of acne range from non-inflammatory comedones to inflammatory nodules. While often perceived as an adolescent disease, the prevalence remains high into adulthood, and the manifestations can have detrimental psychosocial effects. It is therefore not surprising that many patients are motivated to seek treatment. The existing treatment strategies for acne are complex due to the multifactorial pathogenesis of the disease. Although it is difficult to cure, four categories of medications have proved efficacious in reducing acne lesions: topical agents, systemic antibiotics, systemic retinoids, and hormonal agents. Unfortunately, these medications can cause adverse effects that may limit their use. Typically, these adverse effects are mild and transient and can be remedied by altering the dose or frequency of the offending agent. However, more serious adverse effects can occur that pose a significant health risk to the patient. Understanding how to recognize and manage the adverse effects of common acne therapies is imperative to providing the safest and most appropriate treatment for each patient. This article focuses on the recognition and management of adverse effects associated with current acne medications.
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Affiliation(s)
- Mollie D Oudenhoven
- Department of Dermatology, University of North Carolina School of Medicine, 410 Market Street, #400, Chapel Hill, NC, 27516, USA
| | - Megan A Kinney
- Department of Dermatology, University of North Carolina School of Medicine, 410 Market Street, #400, Chapel Hill, NC, 27516, USA
| | - Diana B McShane
- Department of Dermatology, University of North Carolina School of Medicine, 410 Market Street, #400, Chapel Hill, NC, 27516, USA
| | - Craig N Burkhart
- Department of Dermatology, University of North Carolina School of Medicine, 410 Market Street, #400, Chapel Hill, NC, 27516, USA
| | - Dean S Morrell
- Department of Dermatology, University of North Carolina School of Medicine, 410 Market Street, #400, Chapel Hill, NC, 27516, USA.
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Hirfanoglu T, Aydin K, Serdaroglu A, Havali C. Novel Magnetic Resonance Imaging Findings in Children With Intracranial Hypertension. Pediatr Neurol 2015; 53:151-6. [PMID: 26101095 DOI: 10.1016/j.pediatrneurol.2015.03.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/05/2015] [Accepted: 03/08/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Increased intracranial hypertension is defined as elevated intracranial pressure with absence of hydrocephalus, vascular or structural abnormalities, and normal cerebrospinal fluid content. Magnetic resonance imaging abnormalities of the optic nerve and sheath that have been described in adults include increased nerve tortuosity, flattening in posterior aspect of globe, intraocular protrusion of the optic nerve, and enlarged optic nerve sheath. PURPOSE We evaluated accuracy of those proposed markers on magnetic resonance imaging in children with increased intracranial hypertension that are described in adults. MATERIALS AND METHODS Eleven patients between 3 and 15 years of age with intracranial hypertension were selected for re-evaluation of magnetic resonance imaging that had been previously described as normal to determine the presence of: (1) increased tortuosity and elongation of the optic nerve; (2) enlargement of the optic nerve sheath on axial and coronal T2 so called by us "target sign" and postcontrast T1 sequences; (3) flattening in posterior aspect of the globe; and (4) intraocular protrusion of the optic nerve head. RESULTS Of the 11 patients, tortuosity of the optic nerve (10/11, 90.9%) and enlarged optic nerve sheath--target sign (7/11, 63.6%)--were the most common findings. Flattening in the posterior aspect of globe (5/11, 45.5%) and intraocular protrusion (3/11, 27.3%) were also detected as a novel magnetic resonance imaging findings. CONCLUSION Magnetic resonance imaging findings of the optic nerve and sheath include valuable signs of intracranial hypertension not only in adults but also in children. This is the first detailed analysis of the magnetic resonance imaging findings in children with increased intracranial hypertension.
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Affiliation(s)
- Tugba Hirfanoglu
- Department of Pediatric Neurology, School of Medicine, Gazi University, Ankara, Turkey.
| | - Kursad Aydin
- Department of Pediatric Neurology, School of Medicine, Gazi University, Ankara, Turkey
| | - Ayse Serdaroglu
- Department of Pediatric Neurology, School of Medicine, Gazi University, Ankara, Turkey
| | - Cengiz Havali
- Department of Pediatric Neurology, School of Medicine, Gazi University, Ankara, Turkey
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Abstract
The specific aim of this review is to report the features of intracranial pressure changes [spontaneous intracranial hypotension (SIH) and idiopathic intracranial hypertension (IIH)] in children and adolescents, with emphasis on the presentation, diagnosis, and treatment modalities. Headache associated with intracranial pressure changes are relatively rare and less known in children and adolescents. SIH is a specific syndrome involving reduced intracranial pressure with orthostatic headache, frequently encountered connective tissue disorders, and a good prognosis with medical management, initial epidural blood patching, and sometimes further interventions may be required. IIH is an uncommon condition in children and different from the disease in adults, not only with respect to clinical features (likely to present with strabismus and stiff neck rather than headache or pulsatile tinnitus) but also different in outcome. Consequently, specific ICP changes of pediatric ages required specific attention both of exact diagnosis and entire management.
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Paley GL, Sheldon CA, Burrows EK, Chilutti MR, Liu GT, McCormack SE. Overweight and obesity in pediatric secondary pseudotumor cerebri syndrome. Am J Ophthalmol 2015; 159:344-52.e1. [PMID: 25447107 DOI: 10.1016/j.ajo.2014.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/30/2014] [Accepted: 11/01/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To examine the clinical, demographic, and anthropometric patient characteristics of secondary pseudotumor cerebri syndrome in children and adolescents based on the recently revised diagnostic criteria. DESIGN Retrospective observational case series. METHODS Patients seen at a tertiary children's hospital for pseudotumor cerebri syndrome were classified as having either primary idiopathic (n = 59) or secondary pseudotumor cerebri syndrome (n = 16), as rigorously defined by recently revised diagnostic criteria. Outcomes included body mass index Z-scores (BMI-Z), height and weight Z-scores, demographics, and clinical features at presentation, such as headache, sixth nerve palsy, and cerebrospinal fluid (CSF) opening pressure. RESULTS In this cohort, the associated conditions and exposures seen in definite secondary pseudotumor cerebri syndrome included tetracycline-class antibiotics (n = 11), chronic kidney disease (n = 3), withdrawal from chronic glucocorticoids (n = 1), and lithium (n = 1). Other associations observed in the possible secondary pseudotumor cerebri syndrome group included Down syndrome, vitamin A derivatives, and growth hormone. In comparison with primary pseudotumor cerebri syndrome, definite secondary pseudotumor cerebri syndrome patients were on average older (15.0 vs 11.6 years; P = .003, Mann-Whitney test). According to US Centers for Disease Control (CDC) classifications, 79% of children with secondary pseudotumor cerebri syndrome were either overweight or obese (36% overweight [n = 5] and 43% obese [n = 6]), as compared to 32% nationally. CONCLUSIONS Even when a potential inciting exposure is identified for pediatric pseudotumor cerebri syndrome, the possible contribution of overweight and obesity should be considered.
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Andrews LE, Liu GT, Ko MW. Idiopathic intracranial hypertension and obesity. Horm Res Paediatr 2015; 81:217-25. [PMID: 24642712 DOI: 10.1159/000357730] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/04/2013] [Indexed: 11/19/2022] Open
Abstract
Idiopathic intracranial hypertension (IIH), also known as primary pseudotumor cerebri syndrome (PTCS), is a condition of unknown etiology which affects primarily overweight, reproductive-aged women and causes increased intracranial pressure (ICP). This review discusses the recently revised diagnostic criteria for PTCS for adults and children. Additionally, the role of obesity in the epidemiology, etiology, and management of IIH as well as the current knowledge of obesity profiles and markers in IIH are reviewed. We also highlight the emerging, unifying theory of the neuroendocrine effects on the mineralocorticoid receptor to explain a possible mechanism for the increased cerebrospinal fluid production and ICP in secondary PTCS.
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Affiliation(s)
- Laura E Andrews
- Department of Neurology, University Health Care Center, Syracuse, N.Y., USA
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Butori P, Jean-Charles A, Elana G, Merle H. [Pseudotumor cerebri in children with sickle cell disease]. J Fr Ophtalmol 2014; 38:e5-6. [PMID: 25523332 DOI: 10.1016/j.jfo.2014.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 04/24/2014] [Accepted: 04/25/2014] [Indexed: 10/24/2022]
Affiliation(s)
- P Butori
- Service d'ophtalmologie, centre hospitalier universitaire de Fort-de-France, hôpital Pierre-Zobda-Quitman (French West Indies), BP 632, 97261 Fort-de-France cedex, Martinique.
| | - A Jean-Charles
- Service d'ophtalmologie, centre hospitalier universitaire de Fort-de-France, hôpital Pierre-Zobda-Quitman (French West Indies), BP 632, 97261 Fort-de-France cedex, Martinique
| | - G Elana
- Service de pédiatrie, centre hospitalier universitaire de Fort-de-France, hôpital Pierre-Zobda-Quitman, BP 632, 97261 Fort-de-France cedex, Martinique
| | - H Merle
- Service d'ophtalmologie, centre hospitalier universitaire de Fort-de-France, hôpital Pierre-Zobda-Quitman (French West Indies), BP 632, 97261 Fort-de-France cedex, Martinique
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Endoscopic optic nerve fenestration amongst pediatric idiopathic intracranial hypertension: a new surgical option. Int J Pediatr Otorhinolaryngol 2014; 78:1686-91. [PMID: 25103775 DOI: 10.1016/j.ijporl.2014.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 07/13/2014] [Accepted: 07/14/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the effectiveness of transnasal trans-sphenoid endoscopic optic nerve fenestration for the reversal of vision loss in pediatric idiopathic intracranial hypertension (IIH). MATERIAL AND METHODS This is a single center observational retrospective case series. Fifteen diagnosed pediatric patients of IIH satisfying the modified Dandy criteria and reported to the out-patient services of otolaryngology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India were included in this study. All children underwent thorough clinical examination, complete neuro-ophthalmological work up including visual acuity (V/A), visual field charting(V/F), fundus venogram and radiological work up with MRI for special optic nerve sections in sagittal reconstruction. cerebro-spinal fluid pressure (CSF) measured pre operatively for all children. Standard endoscopic optic nerve sheath fenestration was performed on all children. Visual improvement was assessed by comparing pre-operative ophthalmological findings. RESULTS Improvement in vision was taken as a positive outcome. Vision improved in all except two children, who had pre-existing optic nerve atrophy. CONCLUSION Endoscopic optic nerve fenestration is an effective minimally invasive procedure to revert visual loss in pediatric Idiopathic Intracranial Hypertension.
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Değerliyurt A, Teber S, Karakaya G, Güven A, Şeker ED, Arhan EP, Şayli TR. Pseudotumor cerebri/idiopathic intracranial hypertension in children: an experience of a tertiary care hospital. Brain Dev 2014; 36:690-9. [PMID: 24139858 DOI: 10.1016/j.braindev.2013.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 09/16/2013] [Accepted: 09/20/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Pseudotumor cerebri (PTC) is diagnosed at increasing rates probably due to the increase in obesity prevalence all over the world and awareness about the disease. Our aim in this study was to evaluate the PTC clinical picture and etiological factors in children at the present time. METHOD The records of 53 patients with 32 females, who were diagnosed with PTC in a child neurology department between the years of 2005 and 2012 were retrospectively analyzed. RESULTS The mean age at presentation was 10.9 years (3-17 years) and approximately half of patients were aged of 11 years or less. While more than half of prepubertal patients were male, girls rate reaches 74% at puberty. An etiological factor such as venous sinus thrombosis, infections, anemia, steroid discontinuation, drugs, slit ventricle syndrome and minor head injury causing the PTC was identified in 43% of the patients. The mean duration of treatment was 6.4 months (3-24 months) and the mean follow-up duration 16.5 months (3-52 months). Visual field constriction was moderate in only two pubertal and obese female patients and mild in four patients. CONCLUSIONS PTC is seen in prepubertal children as often as in puberty. An etiological factor causing PTC is present in about half the patients in childhood. The main etiological factors of the disease currently consist of cranial venous thrombosis, infections, anemia and drugs. Malnutrition, renutrition and related vitamin deficiencies or excesses commonly seen previously have become less important in PTC etiology. PTC is a disease that requires long-term treatment and follow-up but the prognosis is good in patients who are diagnosed early, receive appropriate treatment and show good compliance with the treatment.
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Affiliation(s)
- Aydan Değerliyurt
- Department of Pediatric Neurology, Ankara Pediatrics, Hematology-Oncology Training and Research Hospital, Ankara, Turkey.
| | - Serap Teber
- Department of Pediatric Neurology, Ankara Pediatrics, Hematology-Oncology Training and Research Hospital, Ankara, Turkey
| | - Gülhan Karakaya
- Department of Pediatrics, Ankara Pediatrics, Hematology-Oncology Training and Research Hospital, Ankara, Turkey
| | - Alev Güven
- Department of Pediatric Neurology, Ankara Pediatrics, Hematology-Oncology Training and Research Hospital, Ankara, Turkey
| | - Esra Dağ Şeker
- Department of Ophthalmology, Ankara Pediatrics, Hematology-Oncology Training and Research Hospital, Ankara, Turkey
| | - Ebru Petek Arhan
- Department of Pediatric Neurology, Ankara Pediatrics, Hematology-Oncology Training and Research Hospital, Ankara, Turkey
| | - Tülin Revide Şayli
- Department of Pediatrics, Ankara Pediatrics, Hematology-Oncology Training and Research Hospital, Ankara, Turkey
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Krishnakumar D, Pickard JD, Czosnyka Z, Allen L, Parker A. Idiopathic intracranial hypertension in childhood: pitfalls in diagnosis. Dev Med Child Neurol 2014; 56:749-55. [PMID: 24854011 DOI: 10.1111/dmcn.12475] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 12/29/2022]
Abstract
AIM Idiopathic intracranial hypertension (IIH) is prone to misdiagnosis. Our aim was to identify the reasons for this in children in our region referred for suspected IIH. METHOD We reviewed the records of all children referred with symptoms and/or signs consistent with raised intracranial pressure (ICP) and normal magnetic resonance imaging of the brain to our tertiary neurology unit over 4 years. IIH was confirmed after expert ophthalmology including ultrasound/tomography and advanced cerebrospinal fluid (CSF) pressure studies. RESULTS Of 15 children (six males, nine females; median age 12y, range 3-15y), six (five females, one male) were confirmed to have IIH. All weighed above the 91st centile and were over 10 years old. Four of the six had raised ICP secondary to other causes. Four had been misdiagnosed locally with papilloedema, three had drusen, and one had 'crowded discs'. Two had raised CSF pressures on standard lumbar puncture, but 20-minute steady state and infusion studies were normal, with symptoms settling after therapy was withdrawn. INTERPRETATION Misdiagnosis of IIH was frequent, but could be reduced by (1) expert ophthalmological fundoscopy, orbital ultrasound, and optical coherence tomography; (2) expert neuroradiology; and (3) assessment of steady state CSF pressure rather than standard opening pressure in centimetres of water.
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Affiliation(s)
- Deepa Krishnakumar
- Department of Paediatric Neurology, Addenbrooke's Hospital, Cambridge, UK
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26
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Abstract
Idiopathic intracranial hypertension (IIH) is a disease of unknown cause typically affecting obese women in the childbearing years. Although headache is the most common symptom, the major morbidity of IIH is visual loss, with 5% to 10% of patients progressing to blindness. While about 95% of patients with IIH have visual loss documented by perimetry, only about one-third notice their visual loss because most loss occurs in the peripheral visual field. Since treatment decisions in IIH are made primarily by changes in visual field function, serial perimetry is the most critical test to obtain when following patients with IIH. This article describes the role of visual field testing in the monitoring of IIH patients in clinical practice, including its importance in communication among providers.
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Kosmorsky GS. Idiopathic Intracranial Hypertension: Pseudotumor Cerebri. Headache 2014; 54:389-93. [DOI: 10.1111/head.12284] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2013] [Indexed: 11/30/2022]
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Abstract
Iatrogenic disease is one of the most frequent causes of hospital admissions and constitutes a growing public health problem. The most common type of iatrogenic neurologic disease is pharmacologic, and the central and peripheral nervous systems are particularly vulnerable. Despite this, iatrogenic disease is generally overlooked as a differential diagnosis among neurologic patients. The clinical picture of pharmacologically mediated iatrogenic neurologic disease can range from mild to fatal. Common and uncommon forms of drug toxicity are comprehensively addressed in this chapter. While the majority of neurologic adverse effects are listed and referenced in the tables, the most relevant issues are further discussed in the text.
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Affiliation(s)
- Luciano A Sposato
- Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Osvaldo Fustinoni
- INEBA Institute of Neurosciences, Buenos Aires, Argentina; Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
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[Sixth, seventh and tenth cranial nerve palsies associated with pseudotumor cerebri in a 13-year-old boy]. J Fr Ophtalmol 2013; 36:e173-6. [PMID: 23731791 DOI: 10.1016/j.jfo.2012.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 11/17/2012] [Accepted: 11/23/2012] [Indexed: 02/03/2023]
Abstract
We describe the case of a 13-year-old boy who presented to the emergency department with an acute onset paresis of the left abducens, facial and vagus nerves. Bilateral papilledema was seen on fundoscopy. Blood tests and brain magnetic resonance imaging and angiography showed no abnormalities. A lumbar puncture revealed an elevated intracranial pressure (575mmH2O) and clear cerebrospinal fluid. The diagnosis of pseudotumor cerebri (PTC) associated with multiple cranial nerve palsies was made. Treatment with acetazolamide was initiated, resulting in progressive improvement with no sequelae and no clinical recurrence over an 8-month follow-up period. PTC in children can present with a wide spectrum of neurological signs, especially cranial nerve palsies which are most likely related to a pressure-dependent stretching mechanism. In 2007, distinctive diagnostic criteria for pediatric PTC were established, including the presence of any cranial nerve palsy in the absence of an identifiable etiology.
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Zakaria Z, Fenton E, Sattar MT. Acute surgical management in idiopathic intracranial hypertension. BMJ Case Rep 2012; 2012:bcr-2012-007949. [PMID: 23239783 DOI: 10.1136/bcr-2012-007949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Idiopathic intracranial hypertension is a headache syndrome with progressive symptoms of raised intracranial pressure. Most commonly, it is a slow process where surveillance and medical management are the main treatment modalities. We describe herein an acute presentation with bilateral sixth nerve palsies, papilloedema and visual deterioration, where acute surgical intervention was a vision-saving operation.
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Affiliation(s)
- Zaitun Zakaria
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland.
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Abstract
Although PTC most frequently occurs in obese females of childbearing age, the syndrome occurs in children as well.(3),(5) Prepubertal children with PTC have a lower incidence of obesity compared with adults and there is no sex predilection. The onset of puberty is best defined by the onset of secondary sexual characteristics such has menarche, pubic hair, and breast development. Children with PTC have a higher incidence of associated conditions and cranial nerve deficits compared with adults. Similar to adult patients, children are at risk for the development of permanent visual loss. In rare instances, children initially diagnosed with PTC will be found to harbor an intracranial neoplasm such as gliomatosis cerebri. An intracranial pressure of 28 cm H2O has recently been established as the upper limit of normal in children.31 Treatment is indicated for the symptomatic management of headaches and to preserve vision. Most children respond to medications such as acetazolamide, furosemide, or topiramate. Surgical treatment such as ONSF and shunting procedures are indicated for children with severe headaches, visual loss, or both despite maximal tolerated medical treatment.
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Affiliation(s)
- Paul H Phillips
- Arkansas Children's Hospital, 1 Children’s Way – Slot 111, Little Rock, AR 72201, USA
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Shofty B, Ben-Sira L, Constantini S, Freedman S, Kesler A. Optic nerve sheath diameter on MR imaging: establishment of norms and comparison of pediatric patients with idiopathic intracranial hypertension with healthy controls. AJNR Am J Neuroradiol 2011; 33:366-9. [PMID: 22116116 DOI: 10.3174/ajnr.a2779] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE IIH is a disorder associated with increased intracranial pressure with no clinical, laboratory, or radiologic evidence of an intracranial space-occupying lesion. The aim of this study was to establish ONSD standards of healthy pediatric subjects and compare the normal measurements with those of patients with IIH. MATERIALS AND METHODS One hundred fifteen MR imaging studies of children 4 months to 17 years of age were blinded and reviewed by a pediatric neuroradiologist. A total of 230 optic nerves were measured. Eighty-six MR imaging examinations were performed in apparently healthy subjects. This control group included subjects who underwent MR imaging for various reasons, and their MR imaging findings were interpreted as normal. Twenty-nine MR imaging examinations were performed in patients with documented IIH. The ONSD was measured 1 cm anterior to the optic foramina on an axial T2 sequence. For statistical analysis, both patients and controls were stratified into 4 age groups (I, 0-3 years; II, 3-6 years; III, 6-12 years; IV, 12-18 years). RESULTS The mean ONSD of the control group in all age groups (I, 3.1 mm; II, 3.41 mm; III, 3.55 mm; IV, 3.56 mm) was significantly smaller than the mean ONSD of patients (I, 4.35 mm; II, 4.37 mm; III, 4.25 mm; IV, 4.69 mm). A positive correlation between age and ONSD (r = 0.414, P < .01) was found in the control group. CONCLUSIONS According to our study, in pediatric patients with IIH, the ONSD is significantly larger than that in healthy controls regardless of age group and sex. This measurement might prove to be an auxiliary tool in the diagnosis of increased intracranial pressure in pediatric patients.
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Affiliation(s)
- B Shofty
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv, Israel
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Soiberman U, Stolovitch C, Balcer LJ, Regenbogen M, Constantini S, Kesler A. Idiopathic intracranial hypertension in children: visual outcome and risk of recurrence. Childs Nerv Syst 2011; 27:1913-8. [PMID: 21538129 DOI: 10.1007/s00381-011-1470-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 04/15/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE Idiopathic intracranial hypertension (IIH) is a disorder associated with increased intracranial pressure without evidence of a space-occupying lesion and with normal cerebrospinal fluid constituents. The disease is rare in the pediatric population. In this study, we assessed the visual outcome of children with IIH and the risk of recurrence. METHODS This single-center observational retrospective cohort study included 90 children younger than 18 years of age who satisfied the modified Dandy criteria for the diagnosis of IIH. Upon follow-up, the treatment was discontinued when patients were free of symptoms such as headaches, transient visual obscurations or tinnitus, and when examination revealed no evidence of papilledema. The main outcome measures were visual acuity and visual field outcomes as well as risk of recurrence. RESULTS The mean follow-up was 30.65 months (range 1.15-172.6 months, standard deviation 27.47 months). Special grading scales were devised for visual acuity and visual field scores. The mean visual acuity score improved from 4.7 ± 0.62 to 4.87 ± 0.44 (p = 0.003).The mean visual field score improved from 3.41 ± 0.8 to 3.52 ± 0.75 (p = 0.21). The recurrence rate was 23.7%, and the risk of recurrence was highest within the first 18 months after diagnosis of IIH. CONCLUSIONS These study results suggest that pediatric patients with IIH have a favorable visual outcome in terms of both visual acuity and visual field. If there is any recurrence, it is most likely to occur during the first 18 months after diagnosis.
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Affiliation(s)
- Uri Soiberman
- Neuro-Opthalmology Unit, Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel.
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Abstract
Purpose To evaluate retrospectively the features, treatment, and outcome of idiopathic intracranial hypertension (IIH) in children. Methods Nine patients, 15 years and younger, diagnosed with IIH. Inclusion criteria were papilledema, normal brain computer tomography or magnetic resonance imaging, cerebrospinal fluid pressure greater than 250 mm H2O, normal cerebrospinal fluid content, and a nonfocal neurologic examination except for sixth nerve palsy. Results Of the nine patients, eight were girls. Five girls were overweight and one boy was obese. The most common presenting symptom was headache (5 patients). Diplopia or strabismus did not occur in our group. Visual field abnormalities were present in all eyes, and severe visual loss resulting in light perception vision occurred in both eyes of one patient. Eight patients were treated medically with acetazolamide alone, and one girl needed a combination of acetazolamide and corticosteroids. This girl also required optic nerve sheath decompression surgery. Resolution of papilledema and recovery of visual function occurred in all patients. Conclusions Idiopathic intracranial hypertension in prepubertal children is rather uncommon. Prompt diagnosis and management are important to prevent permanent visual loss.
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Affiliation(s)
- Nad'a Jirásková
- Department of Ophthalmology, University Hospital, Hradec Králové, Czech Republic
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Aboul Enein HA, Abo Khair AF. Idiopathic intracranial hypertension in children: clinical presentations and management. Middle East Afr J Ophthalmol 2011; 15:113-6. [PMID: 21369466 PMCID: PMC3040914 DOI: 10.4103/0974-9233.51985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Idiopathic intracranial is common in adults, particularly obese young women, but also occurs in children and adolescents. Aim: Clinical presentation of idiopathic intracranial hypertension in the pediatric population and how the presenting signs and symptoms may be different from those seen among adult patients. Results: This study is a prospective study conducted in the Alexandria Medical School, Egypt, between the periods starting from January 2003 till December 2007. Ten patients were included in this study, 9 patients were treated with repeated spinal taps while only one patient necessitated insertion of a theco-peritoneal shunt. Conclusion: Idiopathic intracranial hypertension may occur in children as among adults. If diagnosed early, visual acuity can be saved with proper management.
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Affiliation(s)
- Hisham A Aboul Enein
- Department of Neurosurgery, Faculty of Medicine, Alexandria Medical School, Egypt
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Costenaro F, Rodrigues TC, Ferreira NP, Costa TGD, Schuch T, Boschi V, Czepielewski MA. Pseudotumor cerebri during Cushing's disease treatment with ketoconazole. ACTA ACUST UNITED AC 2011; 55:284-7. [DOI: 10.1590/s0004-27302011000400008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 12/09/2010] [Indexed: 11/22/2022]
Abstract
Benign intracranial hypertension (Pseudotumor cerebri) has been described as related to the reduction in steroid levels in Cushing's disease (CD), especially after surgical remission. Ketoconazole is a common and effective adjuvant therapy for hypercortisolism, but the major concern is liver enzyme dysfunction. We describe here the case of a 12-year old girl with CD who developed benign intracranial hypertension during treatment with ketoconazole. She presented headache, vomiting, a black spot on her right temporal visual field, and signs of elevated intracranial pressure. Pituitary image was normal on magnetic resonance image (MRI), and all symptoms improved after treatment with acetazolamide. We call attention to the diagnosis of this disorder in CD patients, especially children on ketoconazole treatment, because it could be confounded with adrenal insufficiency and lead to definitive severe visual impairment.
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Affiliation(s)
| | | | - Nelson P. Ferreira
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil
| | | | | | | | - Mauro A. Czepielewski
- Hospital de Clínicas de Porto Alegre, Brazil; Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
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Spennato P, Ruggiero C, Parlato RS, Buonocore MC, Varone A, Cianciulli E, Cinalli G. Pseudotumor cerebri. Childs Nerv Syst 2011; 27:215-35. [PMID: 20721668 DOI: 10.1007/s00381-010-1268-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 08/03/2010] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pseudotumor cerebri is a condition characterized by raised intracranial pressure, normal CSF contents, and normal brain with normal or small ventricles on imaging studies. It affects predominantly obese women of childbearing age; however, its incidence seems to be increasing among adolescent and children. While among older children the clinical picture is similar to that of adults, younger children present demographic and clinical peculiarities. Different diagnostic criteria for adults and pre-pubertal children have been proposed. Etiology and pathogenesis are still unclear, particular concerning the role of obstruction to venous outflow. METHODS An extensive literature review concerning all the aspects of pseudotumor cerebri has been performed, both among adults and pre-pubertal children. CONCLUSION Pseudotumor cerebri is an avoidable cause of visual loss, both in adults and children. Few diagnostic measures are usually sufficient to determine the correct diagnosis. Since pseudotumor cerebri is a diagnosis of exclusion, the differential diagnosis work out is of special importance. Modern neuroimaging techniques, especially magnetic resonance imaging and magnetic resonance venography may clarify the role of obstruction to venous outflow in each case. Various therapeutic options are available: medical, surgical, and endovascular procedures may be used to prevent irreversible visual loss. Treatment is usually effective, and most patients will experience complete resolution of symptoms without persistent deficits.
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Affiliation(s)
- Pietro Spennato
- Department of Neurosurgery, Santobono-Paulipon Pediatric Hospital, Via Mario Fiore 6, Naples, Italy.
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Abstract
Idiopathic intracranial hypertension ((IIH) is characterized by increased cerebrospinal fluid pressure of unknown cause. It is predominantly a disease of women in the childbearing years. Although the cause of IIH remains obscure, it has become clear that loss of visual function is common and patients may progress to blindness if untreated. Diagnosis should adhere to the modified Dandy criteria and other causes of intracranial hypertension sought. IIH patient management should include serial perimetry and optic disc grading or photography. The proper therapy can then be selected and visual loss prevented or reversed. Although there are no evidence-based data to guide therapy, there is an ongoing randomized double-blind controlled treatment trial of IIH investigating diet and medical therapy.
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Affiliation(s)
- Michael Wall
- Department of Neurology, College of Medicine, University of Iowa, Veterans Administration Medical Center, Iowa City, IA 52242, USA.
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Skinner AC, Perrin EM, Steiner MJ. Healthy for now? A cross-sectional study of the comorbidities in obese preschool children in the United States. Clin Pediatr (Phila) 2010; 49:648-55. [PMID: 20308197 PMCID: PMC2911579 DOI: 10.1177/0009922810362098] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Examine health of preschoolers by BMI status. METHODS A cross-sectional analysis of children 3 to 5 years old in the 1999-2008 National Health and Nutrition Examination Survey was carried out. The measured age- and sex-specific BMI percentiles were used to categorize children as very obese, obese, overweight, or healthy weight. The authors used logistic regression to examine the effect of weight status on 17 available measures of current child health potentially related to obesity. RESULTS Except for very obese children, weight status had minimal effect on most measures of health for preschool-aged children (n = 2792). Parents of very obese children reported poorer general health and more activity limitations for their children. Additionally, very obese girls had more frequent/severe headaches, and overweight/obese boys had more asthma diagnoses. CONCLUSIONS Only severe obesity appears consistently related to immediate health problems in preschool-aged children. Parental perception that very obese children have worse health and more activity limitations may lead to decreases in physical activity, which would perpetuate obesity.
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Affiliation(s)
| | - Eliana M. Perrin
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Michael J. Steiner
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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Sebestyen J, Warady B. Pseudotumor Cerebri in a Toddler Receiving Recombinant Human Growth Hormone. Perit Dial Int 2010; 30:477-8. [DOI: 10.3747/pdi.2009.00134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J. Sebestyen
- Department of Pediatric Nephrology The Children's Mercy Hospital and Clinics Kansas City, Missouri, USA
| | - B.A. Warady
- Department of Pediatric Nephrology The Children's Mercy Hospital and Clinics Kansas City, Missouri, USA
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Fraser JA, Bruce BB, Rucker J, Fraser LA, Atkins EJ, Newman NJ, Biousse V. Risk factors for idiopathic intracranial hypertension in men: a case-control study. J Neurol Sci 2010; 290:86-9. [PMID: 19945715 PMCID: PMC2815168 DOI: 10.1016/j.jns.2009.11.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 09/30/2009] [Accepted: 11/03/2009] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify risk factors for idiopathic intracranial hypertension (IIH) in men. DESIGN Case-control study. A 96-item telephone questionnaire, answered retrospectively, with cases recalling at the age of their diagnosis and controls recalling at the age of their corresponding case's diagnosis. SETTING Outpatient clinics in two US tertiary care centers. PARTICIPANTS The characteristics of 24 men with IIH were compared to those of 48 controls matched for sex, age, race, and World Health Organization body mass index (BMI) category. MAIN OUTCOME MEASURES Two previously validated questionnaires: the ADAM (Androgen Deficiency in Aging Males) questionnaire for testosterone deficiency and the Berlin questionnaire for obstructive sleep apnea (OSA), embedded within the telephone questionnaire. Analysis with Mantel-Haenszel odds ratios and mixed-effects logistic regression models accounted for matching. RESULTS Cases and controls had similar enrollment matching characteristics. Although matching was successful by BMI category, there was a small difference between BMI values of cases and controls (cases: median 31.7, controls: median 29.9; p=0.03). After adjustment by BMI value, men with IIH were significantly more likely than controls to have a positive ADAM questionnaire for testosterone deficiency (OR: 17.4, 95% CI: 5.6-54.5; p<0.001) and significantly more likely to have either a positive Berlin questionnaire for OSA or history of diagnosed OSA (OR: 4.4, 95% CI: 1.5-12.9; p=0.03). CONCLUSIONS Men with IIH are more likely than controls to have symptoms associated with testosterone deficiency and OSA. These associations suggest a possible role for sex hormones and OSA in the pathogenesis of IIH in men.
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Lim MJ, Pushparajah K, Jan W, Calver D, Lin JP. Magnetic resonance imaging changes in idiopathic intracranial hypertension in children. J Child Neurol 2010; 25:294-9. [PMID: 19638638 DOI: 10.1177/0883073809338874] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To evaluate the usefulness of neuroimaging in children with idiopathic intracranial hypertension, brain magnetic resonance imaging (MRI) scans of children with idiopathic intracranial hypertension and age-matched controls were reviewed. Compared with controls, patients with idiopathic intracranial hypertension had flattening of the posterior sclera in 61% versus 40% of cases, distension of perioptic subarachnoid space in 65% versus 35%, intraocular protrusion of pre-laminar optic nerve in 17% versus 0%, tortuosity of optic nerve in 30% versus 5%, and an empty sella in 26% versus 5% of cases. The presence of 3 or more of the MRI features is 95% specific in predicting idiopathic intracranial hypertension. The observed general anesthetic effect on these neuroimaging features are also minimized when multiple features are taken into account. Magnetic resonance imaging features can assist in suspecting the diagnosis of idiopathic intracranial hypertension in children, provided caution is applied when interpreting imaging performed under a general anesthesia.
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Affiliation(s)
- Ming Jin Lim
- Evelina Children's Hospital, Guys and St Thomas Hospital NHS Foundation Trust, London, United Kingdom.
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Liu GT, Volpe NJ, Galetta SL. Optic disc swelling. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Abstract
An optic nerve sheath fenestration is indicated when papilloedema leads to progressive visual loss despite previous, conservative measures and when no cause of increased intracranial pressure can be indentified and eliminated. This rather rare constellation usually occurs in idiopathic intracranial hypertension. The procedure is performed via a medial transconjunctival orbitotomy. If headaches and neurologic symptoms other than visual deterioration prevail, the placement of a ventricular shunt is preferred. This review covers the symptoms of idiopathic intracranial hypertension and optic nerve sheath fenestration with its technical aspects and results.
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Affiliation(s)
- W A Lagrèze
- Universitäts-Augenklinik Freiburg, Killianstrasse 5, 79106, Freiburg.
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Bynke G, Bynke H, Ljunggren B. Familial idiopathic intracranial hypertension and variegate porphyria-is there any connection?: Report of three sisters. Neuroophthalmology 2009. [DOI: 10.3109/01658109409024043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Parentin F, Marchetti F, Faleschini E, Tonini G, Pensiero S. Acute comitant esotropia secondary to idiopathic intracranial hypertension in a child receiving recombinant human growth hormone. Can J Ophthalmol 2009; 44:110-1. [DOI: 10.3129/i08-158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Zayit-Soudry S, Leibovitch I, Kesler A. Idiopathic intracranial hypertension after 40 years of age: clinical features in 23 patients. Eur J Ophthalmol 2009; 18:989-93. [PMID: 18988173 DOI: 10.1177/112067210801800621] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Idiopathic intracranial hypertension (IIH) is a well-recognized disorder of unknown etiology associated with elevated intracranial pressure (ICP), normal neuroimaging, and normal cerebrospinal fluid (CSF) composition, found mostly among obese females of childbearing age. The aim of this study is to investigate the clinical features of IIH in patients older than 40 years. METHODS This is a retrospective chart review (1998-2007) of all consecutive patients older than 40 years who were diagnosed with IIH based on the Modified Dandy Criteria. RESULTS Twenty three of the 200 IIH patients in the institutional database fulfilled study entry criteria. They included 22 females and one male whose mean age was 51.4 years (range 41-79). Coexisting systemic arterial hypertension was found in 13 (56.5%) patients. Seventeen patients (73.9%) had symptoms attributable to elevated ICP. The most common presenting symptoms were visual; mainly blurred vision and transient visual obscuration (15/17 patients, 88.23%). Eleven patients (64.7%) complained of headache, and another 4 (23.5%) of pulsatile intracranial noise. The average follow up period was 21.8 months. CONCLUSIONS The findings indicate that IIH among individuals older than 40 years of age may be underreported. These patients are more likely to present with systemic hypertension and with more visual disturbances, but with fewer complaints of headache than the younger IIH population.
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Affiliation(s)
- S Zayit-Soudry
- Department of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv - Israel
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Goyal S, Pless ML, Krishnamoorthy K, Butler WE, Noviski N, Gupta P. What's New in Childhood Idiopathic Intracranial Hypertension? Neuroophthalmology 2009. [DOI: 10.1080/01658100902717074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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