1
|
Sheidaee K, Abbaskhanian A, Kali AM, Motlagh FR, Kargar-Soleimanbad S. Combined paralysis of the abducens and facial nerves following idiopathic intracranial hypertension. Int J Surg Case Rep 2024; 122:110071. [PMID: 39053368 DOI: 10.1016/j.ijscr.2024.110071] [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: 07/02/2024] [Accepted: 07/19/2024] [Indexed: 07/27/2024] Open
Abstract
INTRODUCTION Idiopathic intracranial hypertension (IIH) is a clinical phenomenon that reflects an increase in intracranial pressure in the brain with normal parenchyma and no signs of ventriculomegaly, malignancy, infection, or any space-occupying lesion. Generally, this disease is associated with symptoms such as headache, transient visual obscurations (unilateral or bilateral darkening of the vision typically seconds), intracranial noise, diplopia, blurring of vision, abducens nerve palsies, and unilateral or bilateral facial nerve paresis (which is a very rare complication of this disease that has been reported in some studies). CASE PRESENTATION An 8-year-old boy with a history of bilateral frontal headache for 2 weeks, right ear pain, vomiting, and intermittent fever, who had received antibiotics and analgesics with improvement of ear pain and continuation of headache, presented to this center. In the initial neurological examinations, bilateral papilledema and right-sided 6th and 7th cranial nerve palsy (peripheral) were observed. After performing LP and CT scan and MRV for the patient, a diagnosis of pseudotumor cerebri was made and he was treated with acetazolamide, prednisolone, and topiramate. He was discharged after 10 days. CONCLUSION Although pseudotumor cerebri is less common in children than adults and obesity and female gender are considered as risk factors for this disease, it is not usually associated with involvement of the 6th and 7th cranial nerves. However, sometimes this disease can occur in children without any risk factors and with less common involvement of the 6th and 7th cranial nerves.
Collapse
Affiliation(s)
- Kobra Sheidaee
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of medical Sciences, Sari, Iran
| | - Ali Abbaskhanian
- Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of medical Sciences, Sari, Iran
| | - Ali Mohammadi Kali
- Student Research Committee, Faculty of Medicine, Mazandaran University of medical Sciences, Sari, Iran
| | | | - Saeed Kargar-Soleimanbad
- Student Research Committee, Faculty of Medicine, Mazandaran University of medical Sciences, Sari, Iran.
| |
Collapse
|
2
|
Labella Álvarez F, Fernández-Ramos JA, Camino León R, Ibarra de la Rosa E, López Laso E. Pseudotumor cerebri in the paediatric population: clinical features, treatment and prognosis. Neurologia 2024; 39:105-116. [PMID: 38272258 DOI: 10.1016/j.nrleng.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/12/2021] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Pseudotumor cerebri (PC) in prepubertal patients displays certain characteristics that differentiate it from its presentation at the postpubertal stage. The aim of this study is to describe the characteristics of paediatric patients diagnosed with PC at our centre and to compare them according to their pubertal status. PATIENTS AND METHODS We included patients aged between 1 and 18 years who were diagnosed with PC in a tertiary-level hospital between 2006 and 2019 and who met the updated diagnostic criteria for PC. They were classified according to body weight and pubertal status. Subsequently, we analysed results from lumbar punctures, neuroimaging studies, ophthalmological assessments, and treatments received during follow-up. RESULTS We included 28 patients, of whom 22 were of prepubertal age and 6 were of postpubertal age. The mean age (standard deviation) was 9.04 (2.86) years. Among the postpubertal patients, 83.3% were boys, 66.7% of whom presented overweight/obesity. In the group of prepubertal patients, 27% were boys, 31.8% of whom were overweight. The most frequent symptoms were headache (89.9%) and blurred vision (42.9%). All patients presented papilloedema, and 21.4% manifested sixth nerve palsy. Possible triggers were identified in 28.6% of cases. Nineteen percent of patients presented clinical recurrence, all of whom were prepubertal patients. Complete clinical resolution was achieved in 55.6% of patients. CONCLUSION Prepubertal patients with PC show lower prevalence of obesity, higher prevalence of secondary aetiologies, and higher recurrence rates than postpubertal patients.
Collapse
Affiliation(s)
- F Labella Álvarez
- Unidad de Neurología, Hospital Universitario Reina Sofía de Córdoba, Córdoba. Spain.
| | - J A Fernández-Ramos
- Unidad de Neurología Pediátrica, Unidad de Gestión Clínica de Pediatría y sus Especialidades, Hospital Universitario Reina Sofía, Córdoba. Spain
| | - R Camino León
- Unidad de Neurología Pediátrica, Unidad de Gestión Clínica de Pediatría y sus Especialidades, Hospital Universitario Reina Sofía, Córdoba. Spain; Grupo Clínico Vinculado al CIBERER, Área de Medicina Metabólica Hereditaria, Instituto de Salud Carlos III, Madrid, Spain
| | - E Ibarra de la Rosa
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Reina Sofía, Córdoba. Spain
| | - E López Laso
- Unidad de Neurología Pediátrica, Unidad de Gestión Clínica de Pediatría y sus Especialidades, Hospital Universitario Reina Sofía, Córdoba. Spain; Grupo Clínico Vinculado al CIBERER, Área de Medicina Metabólica Hereditaria, Instituto de Salud Carlos III, Madrid, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba. Spain
| |
Collapse
|
3
|
Anemia and Idiopathic Intracranial Hypertension: A Case-Control Study. J Neuroophthalmol 2023; 43:63-68. [PMID: 36166812 DOI: 10.1097/wno.0000000000001664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a condition that mostly affects obese women of childbearing age but has been reported to be temporally related to new diagnoses of anemia. Despite these reports, the association between anemia and IIH remains controversial. The present study aimed to understand the strength of association between anemia and IIH through a case-control design. METHODS Consecutive IIH patients were recruited from neuro-ophthalmology clinics and matched by age and sex to consecutive patients attending neuro-ophthalmology clinics with diagnoses other than IIH. Complete blood counts (CBCs) were reviewed within 6 months of neuro-ophthalmology presentation, and anemia was diagnosed by hemoglobin of <120 g/L in women and <130 g/L in men. Anemia was classified as microcytic (mean corpuscular volume (MCV) < 80 fL), normocytic (MCV 80-100 fL), and macrocytic (MCV > 100 fL) as well as mild (hemoglobin >110 g/L), moderate (hemoglobin 80-109 g/L), and severe (hemoglobin <80 g/L). RESULTS One hundred twenty-three IIH patients and 113 controls were included in the study. More IIH patients than controls had anemia (22.8%, 28/123 vs 10.6%, 12/113, P = 0.01) with an odds ratio of 2.48 (95% CI: 1.19, 5.16). There were no differences in severity of anemia or MCV between IIH patients and controls, with anemia most often being mild (57.1%, 16/28 vs 75%, 9/12) and normocytic (50.0%, 14/28 vs 50.0%, 6/12). However, 17.9% (5/28) of IIH patients had severe anemia compared with zero in the control group. IIH patients had a higher mean platelet count than controls ( P < 0.001), and there were no differences on leukocyte counts. CONCLUSION Idiopathic intracranial hypertension patients have a higher prevalence of anemia compared with non-IIH neuro-ophthalmology patients. The anemia was mostly mild and may be explained by other factors related to worse health status and obesity, including low socioeconomic status, poor nutrition, and polycystic ovary syndrome. However, as a CBC is a widely available test and anemia may influence the IIH disease course, we propose that this test be obtained in all patients with new papilledema.
Collapse
|
4
|
Improving pediatric idiopathic intracranial hypertension care: a retrospective cohort study. Sci Rep 2022; 12:19218. [PMID: 36357479 PMCID: PMC9649632 DOI: 10.1038/s41598-022-23960-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/08/2022] [Indexed: 11/12/2022] Open
Abstract
To describe the clinical course and prognosis of pediatric idiopathic intracranial hypertension (IIH) and examine the preferred management setting. IIH is characterized by increased intracranial pressure and is often associated with headaches and visual complaints. IIH is a preventable cause of vision loss in children. Hence, a rapid diagnosis followed by prompt treatment and follow-up is essential. However, standardization of the management of IIH in the pediatric population is not well established. Computerized medical charts of all 82 pediatric (< 18 years) patients diagnosed with IIH between 2007 and 2018 in the metropolitan area of Jerusalem were reviewed. Comparison was made between children followed in a multidisciplinary clinic in tertiary centers and those followed elsewhere. Detailed demographic and clinical data, as well as data regarding the follow-up setting and clinical course of the disease, were collected and analyzed. Recurrent IIH-related hospital returns were selected as a measurable marker for the uncontrolled disease. Recurrent IIH-related hospital return rate was significantly lower and occurred later among children followed by multidisciplinary teams compared to individual experts. Follow-up in multidisciplinary clinics improve the quality of life, and financial burden and may prevent permanent visual impairment in children with IIH.
Collapse
|
5
|
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.
Collapse
|
6
|
[Pseudotumor cerebri in children and adolescents at the Saarland University Medical Center: a retrospective study]. Wien Med Wochenschr 2022; 173:173-181. [PMID: 35939217 DOI: 10.1007/s10354-022-00950-1] [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: 12/07/2021] [Accepted: 06/14/2022] [Indexed: 11/27/2022]
Abstract
Pseudotumor cerebri (PTC) is defined as a rare disease with a pathological increase in intracranial pressure of unknown origin. The aim of this retrospective study was to establish a uniform diagnostic and therapeutic protocol for children and adolescents for the Saarland University Medical Center. Data from 28 patients with pseudotumor cerebri aged 0-17 years in the period 2008-2018 were retrospectively collected and statistically analyzed. The purpose of this study was to generate a better understanding of the clinical entity of pseudotumor cerebri in children and adolescents. Distinctive features, such as pubertal or adolescent age, female gender and obesity could be highlighted. The data collected in this study were used to develop an in-house standard for the diagnosis and treatment of children and adolescents with pseudotumor cerebri.
Collapse
|
7
|
Chiu HH, Reginald YA, Moharir M, Wan MJ. Secondary pseudotumour cerebri syndrome in children: clinical characteristics and long-term outcomes. Can J Ophthalmol 2022; 57:e216-e218. [PMID: 35341702 DOI: 10.1016/j.jcjo.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/11/2022] [Accepted: 02/25/2022] [Indexed: 11/30/2022]
Affiliation(s)
| | - Y Arun Reginald
- University of Toronto, Toronto, Ont.; Hospital for Sick Children, Toronto, Ont
| | | | - Michael J Wan
- University of Toronto, Toronto, Ont.; Hospital for Sick Children, Toronto, Ont..
| |
Collapse
|
8
|
Labella Álvarez F, Fernández-Ramos JA, Camino León R, Ibarra de la Rosa E, López Laso E. Pseudotumor cerebri in the paediatric population: clinical features, treatment and prognosis. Neurologia 2021; 39:S0213-4853(21)00085-2. [PMID: 34083061 DOI: 10.1016/j.nrl.2021.04.013] [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: 11/04/2020] [Revised: 04/03/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Pseudotumor cerebri (PC) in prepubertal patients displays certain characteristics that differentiate it from its presentation at the postpubertal stage. The aim of this study is to describe the characteristics of paediatric patients diagnosed with PC at our centre and to compare them according to their pubertal status. PATIENTS AND METHODS We included patients aged between 1 and 18 years who were diagnosed with PC in a tertiary-level hospital between 2006 and 2019 and who met the updated diagnostic criteria for PC. They were classified according to body weight and pubertal status. Subsequently, we analysed results from lumbar punctures, neuroimaging studies, ophthalmological assessments, and treatments received during follow-up. RESULTS We included 28 patients, of whom 22 were of prepubertal age and 6 were of postpubertal age. The mean age (standard deviation) was 9.04 (2.86) years. Among the postpubertal patients, 83.3% were boys, 66.7% of whom presented overweight/obesity. In the group of prepubertal patients, 27% were boys, 31.8% of whom were overweight. The most frequent symptoms were headache (89.9%) and blurred vision (42.9%). All patients presented papilloedema, and 21.4% manifested sixth nerve palsy. Possible triggers were identified in 28.6% of cases. Nineteen percent of patients presented clinical recurrence, all of whom were prepubertal patients. Complete clinical resolution was achieved in 55.6% of patients. CONCLUSION Prepubertal patients with PC show lower prevalence of obesity, higher prevalence of secondary aetiologies, and higher recurrence rates than postpubertal patients.
Collapse
Affiliation(s)
- F Labella Álvarez
- Unidad de Neurología, Hospital Universitario Reina Sofía de Córdoba, Córdoba, España.
| | - J A Fernández-Ramos
- Unidad de Neurología Pediátrica. Unidad de Gestión Clínica de Pediatría y sus Especialidades. Hospital Universitario Reina Sofía, Córdoba, España
| | - R Camino León
- Unidad de Neurología Pediátrica. Unidad de Gestión Clínica de Pediatría y sus Especialidades. Hospital Universitario Reina Sofía, Córdoba, España; Grupo clínico vinculado al CIBERER, Área de Medicina Metabólica Hereditaria, Instituto de Salud Carlos III, Madrid, España
| | - E Ibarra de la Rosa
- Unidad de Gestión Clínica de Oftalmología, Hospital Universitario Reina Sofía, Córdoba, España
| | - E López Laso
- Unidad de Neurología Pediátrica. Unidad de Gestión Clínica de Pediatría y sus Especialidades. Hospital Universitario Reina Sofía, Córdoba, España; Grupo clínico vinculado al CIBERER, Área de Medicina Metabólica Hereditaria, Instituto de Salud Carlos III, Madrid, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España
| |
Collapse
|
9
|
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] [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.
Collapse
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.
| |
Collapse
|
10
|
|
11
|
Mahajnah M, Genizi J, Zahalka H, Andreus R, Zelnik N. Pseudotumor Cerebri Syndrome: From Childhood to Adulthood Risk Factors and Clinical Presentation. J Child Neurol 2020; 35:311-316. [PMID: 31928127 DOI: 10.1177/0883073819895179] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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.
Collapse
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
| |
Collapse
|
12
|
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] [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.
Collapse
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
| |
Collapse
|
13
|
Balbi GGM, Matas SL, Len CA, Fraga MM, Sousa IO, Terreri MT. Pseudotumor cerebri in childhood and adolescence: data from a specialized service. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:751-755. [DOI: 10.1590/0004-282x20180131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 08/15/2018] [Indexed: 11/21/2022]
Abstract
ABSTRACT Objective: To report cases of children and adolescents diagnosed with pseudotumor cerebri associated or not with rheumatic disease. Methods: This was a retrospective study based on medical reports of 29 patients, up to 18 years of age and diagnosed with pseudotumor cerebri, followed up in the Pediatric Rheumatology and Neurology outpatient clinics of a tertiary hospital, until December 2016. Results: Among the 29 patients diagnosed with pseudotumor cerebri, 51.7% were girls and the mean age at the disease onset was 12.3 years. In 18 patients (62%) where an etiology was found, four were associated with a rheumatic disease. The most common symptom was headache (69%) and acetazolamide was the most used medication (69%). Two patients developed blindness and 10 are still being followed up. Conclusion: Although rare, pseudotumor cerebri should be considered in children with headaches, especially in patients with rheumatic disease.
Collapse
|
14
|
Soroken C, Lacroix L, Korff CM. Combined VIth and VIIth nerve palsy: Consider idiopathic intracranial hypertension! Eur J Paediatr Neurol 2016; 20:336-338. [PMID: 26653361 DOI: 10.1016/j.ejpn.2015.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/09/2015] [Accepted: 11/10/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a rare condition in children. VIth nerve palsy is the most common cranial nerve deficit related to that condition. Other cranial nerve dysfunctions have also been described but remain rare in paediatric daily practice. CASE PRESENTATION We here report the case of a 13-year-old girl who presented with VIth and contralateral VIIth nerve palsy due to IIH. CONCLUSION Although rarely encountered, paediatricians should be familiar with the possible association of VIth and contralateral VIIth nerve palsy in children suffering from IIH. Moreover, other cranial nerve deficits may also be affected.
Collapse
Affiliation(s)
- Cindy Soroken
- Paediatric Emergency Medicine Department, Child and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland.
| | - Laurence Lacroix
- Paediatric Emergency Medicine Department, Child and Adolescent Medicine, Geneva University Hospitals, Geneva, Switzerland.
| | - Christian M Korff
- Paediatric Neurology, Child and Adolescent Department, University Hospitals, Geneva, Switzerland.
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Millichap JG, Millichap JJ. Symptoms and Etiologies of Pseudotumor Cerebri. Pediatr Neurol Briefs 2014. [DOI: 10.15844/pedneurbriefs-28-10-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
17
|
Classification of the intracranial hypertension and characteristics of intracranial pressure increase. Review. ROMANIAN NEUROSURGERY 2013. [DOI: 10.2478/romneu-2013-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|