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Foust AM, Johnstone L, Krishnasarma R, Martin DC, Vaughn J, Shekdar K, Snyder E, Todd T, Pruthi S, Sarma A. Nontraumatic Pediatric Head and Neck Emergencies: Resource for On-Call Radiologists. Radiographics 2024; 44:e240027. [PMID: 39264838 DOI: 10.1148/rg.240027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2024]
Abstract
The vast array of acute nontraumatic diseases encountered in the head and neck of pediatric patients can be intimidating for radiologists in training in a fast-paced emergency setting. Although there is some overlap of pediatric and adult diseases, congenital lesions and developmental variants are much more common in the pediatric population. Furthermore, the relative incidences of numerous infections and neoplasms differ between pediatric and adult populations. Young patients and/or those with developmental delays may have clinical histories that are difficult to elicit or nonspecific presentations, underscoring the importance of imaging in facilitating accurate and timely diagnoses. It is essential that radiologists caring for children be well versed in pediatric nontraumatic head and neck emergency imaging. The authors provide an on-call resource for radiology trainees, organized by anatomic location and highlighting key points, pearls, pitfalls, and mimics of many acute nontraumatic diseases in the pediatric head and neck. ©RSNA, 2024 Supplemental material is available for this article.
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Affiliation(s)
- Alexandra M Foust
- From the Department of Radiology, Monroe Carell Jr Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN 37232 (A.M.F., L.J., R.K., D.C.M., E.S., T.T., S.P., A.S.); Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ (J.V.); and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA (K.S.)
| | - Lindsey Johnstone
- From the Department of Radiology, Monroe Carell Jr Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN 37232 (A.M.F., L.J., R.K., D.C.M., E.S., T.T., S.P., A.S.); Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ (J.V.); and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA (K.S.)
| | - Rekha Krishnasarma
- From the Department of Radiology, Monroe Carell Jr Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN 37232 (A.M.F., L.J., R.K., D.C.M., E.S., T.T., S.P., A.S.); Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ (J.V.); and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA (K.S.)
| | - Dann C Martin
- From the Department of Radiology, Monroe Carell Jr Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN 37232 (A.M.F., L.J., R.K., D.C.M., E.S., T.T., S.P., A.S.); Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ (J.V.); and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA (K.S.)
| | - Jennifer Vaughn
- From the Department of Radiology, Monroe Carell Jr Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN 37232 (A.M.F., L.J., R.K., D.C.M., E.S., T.T., S.P., A.S.); Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ (J.V.); and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA (K.S.)
| | - Karuna Shekdar
- From the Department of Radiology, Monroe Carell Jr Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN 37232 (A.M.F., L.J., R.K., D.C.M., E.S., T.T., S.P., A.S.); Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ (J.V.); and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA (K.S.)
| | - Elizabeth Snyder
- From the Department of Radiology, Monroe Carell Jr Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN 37232 (A.M.F., L.J., R.K., D.C.M., E.S., T.T., S.P., A.S.); Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ (J.V.); and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA (K.S.)
| | - Ty Todd
- From the Department of Radiology, Monroe Carell Jr Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN 37232 (A.M.F., L.J., R.K., D.C.M., E.S., T.T., S.P., A.S.); Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ (J.V.); and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA (K.S.)
| | - Sumit Pruthi
- From the Department of Radiology, Monroe Carell Jr Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN 37232 (A.M.F., L.J., R.K., D.C.M., E.S., T.T., S.P., A.S.); Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ (J.V.); and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA (K.S.)
| | - Asha Sarma
- From the Department of Radiology, Monroe Carell Jr Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN 37232 (A.M.F., L.J., R.K., D.C.M., E.S., T.T., S.P., A.S.); Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ (J.V.); and Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA (K.S.)
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Matsunaga K, Chang M. Distinguishing Papilledema from Pseudopapilledema in Children. ADVANCES IN OPHTHALMOLOGY AND OPTOMETRY 2024; 9:221-233. [PMID: 39247852 PMCID: PMC11376428 DOI: 10.1016/j.yaoo.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Affiliation(s)
- Kate Matsunaga
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | - Melinda Chang
- Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
- Children's Hospital Los Angeles, Los Angeles, CA, USA
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Chang MY, Heidary G, Beres S, Pineles SL, Gaier ED, Gise R, Reid M, Avramidis K, Rostami M, Narayanan S. Artificial Intelligence to Differentiate Pediatric Pseudopapilledema and True Papilledema on Fundus Photographs. OPHTHALMOLOGY SCIENCE 2024; 4:100496. [PMID: 38682028 PMCID: PMC11046195 DOI: 10.1016/j.xops.2024.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 05/01/2024]
Abstract
Purpose To develop and test an artificial intelligence (AI) model to aid in differentiating pediatric pseudopapilledema from true papilledema on fundus photographs. Design Multicenter retrospective study. Subjects A total of 851 fundus photographs from 235 children (age < 18 years) with pseudopapilledema and true papilledema. Methods Four pediatric neuro-ophthalmologists at 4 different institutions contributed fundus photographs of children with confirmed diagnoses of papilledema or pseudopapilledema. An AI model to classify fundus photographs as papilledema or pseudopapilledema was developed using a DenseNet backbone and a tribranch convolutional neural network. We performed 10-fold cross-validation and separately analyzed an external test set. The AI model's performance was compared with 2 masked human expert pediatric neuro-ophthalmologists, who performed the same classification task. Main Outcome Measures Accuracy, sensitivity, and specificity of the AI model compared with human experts. Results The area under receiver operating curve of the AI model was 0.77 for the cross-validation set and 0.81 for the external test set. The accuracy of the AI model was 70.0% for the cross-validation set and 73.9% for the external test set. The sensitivity of the AI model was 73.4% for the cross-validation set and 90.4% for the external test set. The AI model's accuracy was significantly higher than human experts on the cross validation set (P < 0.002), and the model's sensitivity was significantly higher on the external test set (P = 0.0002). The specificity of the AI model and human experts was similar (56.4%-67.3%). Moreover, the AI model was significantly more sensitive at detecting mild papilledema than human experts, whereas AI and humans performed similarly on photographs of moderate-to-severe papilledema. On review of the external test set, only 1 child (with nearly resolved pseudotumor cerebri) had both eyes with papilledema incorrectly classified as pseudopapilledema. Conclusions When classifying fundus photographs of pediatric papilledema and pseudopapilledema, our AI model achieved > 90% sensitivity at detecting papilledema, superior to human experts. Due to the high sensitivity and low false negative rate, AI may be useful to triage children with suspected papilledema requiring work-up to evaluate for serious underlying neurologic conditions. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Melinda Y. Chang
- Division of Ophthalmology, Children’s Hospital Los Angeles, Los Angeles, California
- Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Gena Heidary
- Department of Ophthalmology, Boston Children’s Hospital, Boston, Massachusetts
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Shannon Beres
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California
| | - Stacy L. Pineles
- Department of Ophthalmology, Stein Eye Institute, University of California, Los Angeles, Los Angeles, California
| | - Eric D. Gaier
- Department of Ophthalmology, Boston Children’s Hospital, Boston, Massachusetts
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Ryan Gise
- Department of Ophthalmology, Boston Children’s Hospital, Boston, Massachusetts
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Mark Reid
- Division of Ophthalmology, Children’s Hospital Los Angeles, Los Angeles, California
| | - Kleanthis Avramidis
- Viterbi School of Engineering, University of Southern California, Los Angeles, California
| | - Mohammad Rostami
- Viterbi School of Engineering, University of Southern California, Los Angeles, California
- Information Sciences Institute, University of Southern California, Los Angeles, California
| | - Shrikanth Narayanan
- Viterbi School of Engineering, University of Southern California, Los Angeles, California
- Information Sciences Institute, University of Southern California, Los Angeles, California
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El-Gendy RS, El-Hamid ASA, Galhom AESA, Hassan NA, Ghoneim EM. Diagnostic dilemma of papilledema and pseudopapilledema. Int Ophthalmol 2024; 44:272. [PMID: 38916684 DOI: 10.1007/s10792-024-03215-5] [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: 09/06/2023] [Accepted: 06/16/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Papilledema is the optic disc swelling caused by increased intracranial pressure (ICP) that can damage the optic nerve and cause subsequent vision loss. Pseudopapilledema refers to optic disc elevation without peripapillary fluid that can arise from several optic disc disorders, with optic disc drusen (ODD) being the most frequent cause. Occasionally, pseudopapilledema patients are mistakenly diagnosed as papilledema, leading to the possibility of unneeded procedures. We aim to thoroughly examine the most current evidence on papilledema and pseudopapilledema causes and several methods for distinguishing between both conditions. METHODS An extensive literature search was conducted on electronic databases including PubMed and google scholar using keywords that were relevant to the assessed pathologies. Data were collected and then summarized in comprehensive form. RESULTS Various techniques are employed to distinguish between papilledema and pseudopapilledema. These techniques include Fundus fluorescein angiography, optical coherence tomography, ultrasonography, and magnetic resonance imaging. Lumbar puncture and other invasive procedures may be needed if results are suspicious. CONCLUSION Papilledema is a sight-threatening condition that may lead to visual affection. Many disc conditions may mimic papilledema. Accordingly, differentiation between papilledema and pseudopailledema is crucial and can be conducted through many modalities.
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Affiliation(s)
| | | | | | - Nihal Adel Hassan
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ehab Mahmoud Ghoneim
- Department of Ophthalmology, Faculty of Medicine, PortSaid University, PortSaid, Egypt
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Lin MY, Najjar RP, Tang Z, Cioplean D, Dragomir M, Chia A, Patil A, Vasseneix C, Peragallo JH, Newman NJ, Biousse V, Milea D. The BONSAI (Brain and Optic Nerve Study with Artificial Intelligence) deep learning system can accurately identify pediatric papilledema on standard ocular fundus photographs. J AAPOS 2024; 28:103803. [PMID: 38216117 DOI: 10.1016/j.jaapos.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/26/2023] [Accepted: 10/15/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Pediatric papilledema often reflects an underlying severe neurologic disorder and may be difficult to appreciate, especially in young children. Ocular fundus photographs are easy to obtain even in young children and in nonophthalmology settings. The aim of our study was to ascertain whether an improved deep-learning system (DLS), previously validated in adults, can accurately identify papilledema and other optic disk abnormalities in children. METHODS The DLS was tested on mydriatic fundus photographs obtained in a multiethnic pediatric population (<17 years) from three centers (Atlanta-USA; Bucharest-Romania; Singapore). The DLS's multiclass classification accuracy (ie, normal optic disk, papilledema, disks with other abnormality) was calculated, and the DLS's performance to specifically detect papilledema and normal disks was evaluated in a one-vs-rest strategy using the AUC, sensitivity and specificity, with reference to expert neuro-ophthalmologists. RESULTS External testing was performed on 898 fundus photographs: 447 patients; mean age, 10.33 (231 patients ≤10 years of age; 216, 11-16 years); 558 normal disks, 254 papilledema, 86 other disk abnormalities. Overall multiclass accuracy of the DLS was 89.6% (range, 87.8%-91.6%). The DLS successfully distinguished "normal" from "abnormal" optic disks (AUC 0.99 [0.98-0.99]; sensitivity, 87.3% [84.9%-89.8%]; specificity, 98.5% [97.6%-99.6%]), and "papilledema" from "normal and other" (AUC 0.99 [0.98-1.0]; sensitivity, 98.0% [96.8%-99.4%]; specificity, 94.1% (92.4%-95.9%)]. CONCLUSIONS Our DLS reliably distinguished papilledema from normal optic disks and other disk abnormalities in children, suggesting it could be utilized as a diagnostic aid for the assessment of optic nerve head appearance in the pediatric age group.
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Affiliation(s)
- Mung Yan Lin
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia
| | - Raymond P Najjar
- Visual Neuroscience Research Group, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore; Center for Innovation & Precision Eye Health, Department of Ophthalmology and Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore
| | - Zhiqun Tang
- Visual Neuroscience Research Group, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | | | | | - Audrey Chia
- Duke-NUS Medical School, Singapore; Center for Innovation & Precision Eye Health, Department of Ophthalmology and Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Paediatric and Strabismus Service, Singapore National Eye Centre, Singapore; Myopia Research Group, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Ajay Patil
- Department of Ophthalmology, University Hospitals Birmingham, Birmingham, England, United Kingdom
| | - Caroline Vasseneix
- Visual Neuroscience Research Group, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
| | - Jason H Peragallo
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia; Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Dan Milea
- Visual Neuroscience Research Group, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Duke-NUS Medical School, Singapore; Angers University Hospital, Angers, France; University of Copenhagen, Denmark; Rothschild Foundation Hospital, Paris, France; Neuro-Ophthalmology Department, Singapore National Eye Centre, Singapore.
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Li Y, Dai S. Clinical approach for suspected optic disc swelling in children: recommendations based on a six-year review. Clin Exp Optom 2023; 106:793-799. [PMID: 36634626 DOI: 10.1080/08164622.2022.2156775] [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: 10/07/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 01/14/2023] Open
Abstract
CLINICAL RELEVANCE Suspected optic disc swelling is a common presentation in children. The delineation between true optic disc swelling and pseudopapilloedema, its common masquerade, requires careful evaluation. A streamlined pathway is required to avoid unnecessary investigations. BACKGROUND Papilloedema requires urgent neuroimaging, however, perceived optic disc swelling is not always true papilloedema. This study aims to investigate the outcome of referrals for optic disc swelling and formulate features that may assist in investigation and diagnosis. METHODS A retrospective review of referrals for optic disc swelling to the Queensland Children's Hospital, Australia, between January 2014 and June 2020 was undertaken. RESULTS Four hundred and ten children were referred for optic disc swelling. Sixty-six patients were confirmed with optic disc swelling, and 344 patients had pseudopapilloedema. The average age was 10.10 ± 3.57 and 9.90 ± 3.50 years, respectively. The most common aetiology of optic disc swelling was idiopathic intracranial hypertension (n = 25). Optic disc drusen constituted the majority of pseudopapilloedema (n = 239) and the remainder were crowded/tilted discs (n = 105). True optic disc swelling patients were more likely to experience headache (OR = 8.68, p < 0.01) and visual disturbance (OR = 2.14, p = 0.03). B-scan was the most sensitive for the detection of optic disc drusen (100%), followed by optical coherence tomography (70.38%) and fundus autofluorescence (44.86%). The retinal nerve fibre layer thickness was significantly thicker in true optic disc swelling compared to pseudopapilloedema (p < 0.01). Twenty-two (33.33%) true optic disc swelling patients and 33 (9.59%) pseudopapilloedema patients underwent neuroimaging prior to ophthalmology review. CONCLUSIONS Suspected optic disc swelling in children is most likely pseudopapilloedema. Referrals should include neurological assessment, visual acuity, fundus photography, and optical coherence tomography to assist in the triage for ophthalmic review. Neuroimaging prior to ophthalmic review should be discouraged for children without neurological symptoms.
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Affiliation(s)
- Ye Li
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Shuan Dai
- Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Tagliani S, Malaventura C, Ceccato C, Parmeggiani F, Suppiej A. Leber Mitochondrial Optic Neuropathy in Pediatric Females With Focus on Very Early Onset Cases. J Child Neurol 2023; 38:5-15. [PMID: 36659874 DOI: 10.1177/08830738221149962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The aim of this study was to describe the phenotype of Leber hereditary optic neuropathy occurring in pediatric females. This disease generally affects young adult males, but it can occur also in females, and research data in this population is lacking. The very early onset can challenge the diagnosis and delay treatment. We searched PubMed through February 2021 and identified 226 pediatric females with genetically confirmed Leber hereditary optic neuropathy and added a new case of a 3-year-old female. The male-female ratio was 1.8:1; the mean onset age in females was 11 years with the onset at 3 years of age occurring in 3 females only. Acute onset with mild visual impairment was the most common presentation, associated with optic disc edema in 16%. Differential diagnoses are pseudotumor cerebri, optic nerve drusen and optic neuritis. The outcome is poor with partial recovery in 50%, despite some receiving Idebenone therapy.
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Affiliation(s)
- Sara Tagliani
- Department of Medical Sciences, Pediatric Section, University Hospital of Ferrara, Ferrara, Italy
| | - Cristina Malaventura
- Department of Medical Sciences, Pediatric Section, University Hospital of Ferrara, Ferrara, Italy
| | | | - Francesco Parmeggiani
- Department of Translational Medicine and for Romagna, 9299University of Ferrara, Ferrara, Italy.,ERN-EYE Network - Center for Retinitis Pigmentosa of Veneto Region, 196013Camposampiero Hospital, Padova, Italy
| | - Agnese Suppiej
- Department of Medical Sciences, Pediatric Section, University Hospital of Ferrara, Ferrara, Italy.,87812Robert Hollman Foundation, Padova, Italy.,ERN-EYE Network - Center for Retinitis Pigmentosa of Veneto Region, 196013Camposampiero Hospital, Padova, Italy
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Oral Fluorescein Angiography for the Diagnosis of Papilledema Versus Pseudopapilledema in Children. Am J Ophthalmol 2023; 245:8-13. [PMID: 36084685 DOI: 10.1016/j.ajo.2022.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To evaluate the accuracy and safety of oral fluorescein angiography (OFA) in differentiating papilledema from pseudopapilledema in pediatric patients. DESIGN Retrospective evaluation of a diagnostic test. METHODS We retrospectively reviewed medical records of all children ≤18 years of age who presented to the Arkansas Children's Hospital between May 2018 and August 2021 with suspected optic disc (OD) swelling that had OFA and images >30 minutes after oral ingestion. Two masked specialists interpreted the images as either OD leakage, no leakage, or borderline leakage. Optic disc swelling was graded clinically according to the Frisen grading scale (0-5). We compared OFA images to the final clinical diagnosis and calculated the accuracy of the test as follows: (number of eyes correctly identified as papilledema [true positive] + number of eyes correctly identified as pseudopapilledema [true negative]) / (total number of eyes) × 100%. RESULTS Forty-five patients (90 eyes) were included, 11 patients with papilledema and 34 with pseudopapilledema. The mean age was 14.1 ± 3.5 years; 66.7% were female. The accuracy of OFA was 62% for reviewer 1 and 69% for reviewer 2. No ocular or systemic side effects after OFA were observed. There was substantial agreement (k = 0.779) between both reviewers in grading the OFA images. CONCLUSION OFA cannot definitively distinguish papilledema from pseudopapilledema in children and should be interpreted in conjunction with other clinical findings.
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Papageorgiou E, Lazari K, Gottlob I. Hand-held optical coherence tomography: advancements in detection and assessment of optic nerve abnormalities and disease progression monitoring. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2060821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Eleni Papageorgiou
- Department of Ophthalmology, University Hospital of Larissa, Larissa, Greece
| | - Katerina Lazari
- Department of Ophthalmology, University Hospital of Larissa, Larissa, Greece
| | - Irene Gottlob
- Department of Neurology, Cooper Medical School of Rowan University and Cooper University Healthcare, Camden, New Jersey, USA
- Ulverscroft Eye Unit, Neuroscience, Psychology and Behaviour, Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, University of Leicester, UK
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Ataei Y, Samara WA, Felton WL, Brar VS. Incomplete Vogt-Koyanagi-Harada in a 14-year-Old African American female with bilateral disc edema. Am J Ophthalmol Case Rep 2021; 22:101114. [PMID: 34013096 PMCID: PMC8113827 DOI: 10.1016/j.ajoc.2021.101114] [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: 11/11/2020] [Revised: 02/04/2021] [Accepted: 04/24/2021] [Indexed: 10/28/2022] Open
Abstract
Purpose To report an unusual case of incomplete Vogt-Koyanagi-Harada (VKH) in a 14-Year-Old African American female. Observations Here we present a 14-Year-Old African American Female with incomplete VKH who presented to the emergency department with a one-month history of malaise, fever, bilateral decreased vision and temporal headaches. At the time of presentation, she was found to have bilateral anterior uveitis and disc edema. The brain and orbit MRI were unremarkable, CSF analysis showed lymphocytic pleocytosis with negative cultures and gram stain. An extensive lab workup was unrevealing. Conclusion This is an unusual case of incomplete VKH in a young African American female presenting with anterior uveitis and disc edema without serous retinal detachments. Initiation of high dose oral prednisone promptly after diagnosis resulted in rapid improvement of symptoms and improvement in visual acuity with the resolution of the disc edema. This case highlights the importance of considering VKH in the differential diagnosis of disc edema associated with uveitis, even in the absence of serous retinal detachment.
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Affiliation(s)
- Yasaman Ataei
- Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA, USA
| | - Wasim A Samara
- Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA, USA
| | - Warren L Felton
- Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA, USA
| | - Vikram S Brar
- Virginia Commonwealth University Health Systems, 1250 E Marshall St, Richmond, VA, USA
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