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Andreão FF, Ferreira MY, Oliveira LDB, Sousa MP, Palavani LB, Rairan LG, Tinti ISU, Júnyor FDS, Batista S, Bertani R, Amarillo DG, Daccach FH. Effectiveness and Safety of Ventriculoperitoneal Shunt Versus Lumboperitoneal Shunt for Idiopathic Intracranial Hypertension: A Systematic Review and Comparative Meta-Analysis. World Neurosurg 2024; 185:359-369.e2. [PMID: 38428810 DOI: 10.1016/j.wneu.2024.02.095] [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: 01/29/2024] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION Idiopathic Intracranial Hypertension (IIH) is a condition characterized by elevated intracranial pressure. Although several mechanisms have been proposed as underlying causes of IIH, no identifiable causative factor has been determined for this condition. Initial treatments focus on weight or CSF reduction, but severe cases may require surgery. This study compares outcomes in IIH patients treated with lumboperitoneal shunts (LPSs) versus ventriculoperitoneal shunts (VPSs). METHODS This systematic-review and meta-analysis follows Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and includes studies about VPS and LPS patients, reporting one of the outcomes of interest. We conducted searches on PubMed, Embase, Web of Science, and Cochrane Library. RESULTS Our analysis involved twelve studies, comprising 5990 patients. The estimated odds ratio (OR) for visual improvement was 0.97 (95% CI 0.26-3.62; I2 = 0%) and for headache improvement was 0.40 (95% CI 0.20-0.81; I2 = 0%), favoring LPS over VPS. Shunt revision analysis revealed an OR of 1.53 (95% CI 0.97-2.41; I2 = 77%). The shunt complications showed an OR of 0.91 (95% CI 0.68-1.22; I2 = 0%). The sub-analyses for shunt failure uncovered an OR of 1.41 (95% CI 0.92-2.18; I2 = 25%) and for shunt infection events an OR of 0.94 (95% CI 0.50-1.75; I2 = 0%). CONCLUSIONS The interventions showed general equivalence in complications, shunt failure, and other outcomes, but LPS seems to hold an advantage in improving headaches. Substantial heterogeneity highlights the need for more conclusive evidence, emphasizing the crucial role for further studies. The findings underscore the importance of considering a tailored decision between VPS and LPS for the management of IIH patients.
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Affiliation(s)
- Filipi Fim Andreão
- Department of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Marcelo Porto Sousa
- Department of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Lucca B Palavani
- Department of Neurosurgery, Max Planck University Center, Indaiatuba, São Paulo, Brazil.
| | - Luis García Rairan
- Neurosurgery Resident, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Isadora Santo Urbano Tinti
- Department of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flavio de Souza Júnyor
- Department of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sávio Batista
- Department of Neurosurgery, Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil
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Pabst L, Aylward BS, Rogers DL, Aylward SC. Persistent Elevation of Opening Pressure Despite Treatment and Symptom Resolution in Pediatric Intracranial Hypertension. Pediatr Neurol 2024; 153:92-95. [PMID: 38354628 DOI: 10.1016/j.pediatrneurol.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 11/04/2023] [Accepted: 12/18/2023] [Indexed: 02/16/2024]
Abstract
BACKGROUND Currently no guidelines for repeating a lumbar puncture to guide management in primary intracranial hypertension (PIH) exist. METHODS An institutional database of patients 18 years and younger followed in the institution's pediatric intracranial hypertension clinic was examined for opening pressure changes in PIH at diagnosis, before medication wean, and following medication wean, as well as to examine whether measurements at the time of diagnosis differed between those with and without disease recurrence. RESULTS Forty-two patients were included in this study; 36% were male and the mean age at diagnosis was 11.01 years. Treatment duration averaged 9.68 months in those without recurrence and 8.5 months in those with recurrence. Average body mass index percentile of patients with disease recurrence was 83.7 and 72.1 in those without recurrence (P = 0.16). Average opening pressure values of all patients at diagnosis, prewean, and postwean was 36.53 cm H2O, 30.7 cm H2O, and 31.1 cm H2O, respectively. There was no statistically significant difference in opening pressures across these time points (P = 0.14). The change in opening pressure from diagnosis to postwean was statistically significant with a reduction of 5.18 cm H2O (P = 0.04). There was no statistical difference between change in opening pressure at diagnosis versus postwean between those with and without recurrence (P = 0.17). CONCLUSIONS This clinical observational study suggests that mean opening pressure measurements in patients with PIH remain elevated both before and after medication wean despite papilledema resolution and patient-reported PIH symptoms. Clinically, this suggests that other features such as signs of optic disc edema and symptoms should be used to inform a clinical determination of disease recurrence and treatment course.
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Affiliation(s)
- Lisa Pabst
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | - Brandon S Aylward
- RTI Health Advance, RTI International, Research Triangle Park, North Carolina
| | - David L Rogers
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio
| | - Shawn C Aylward
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio.
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Bulkowstein Y, Nitzan-Luques A, Schnapp A, Barnoy N, Reif S, Gilboa T, Volovesky O. The manifestations of metabolic acidosis during acetazolamide treatment in a cohort of pediatric idiopathic intracranial hypertension. Pediatr Nephrol 2024; 39:185-191. [PMID: 37480382 DOI: 10.1007/s00467-023-06084-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Idiopathic intracranial hypertension is characterized by increased intracranial pressure with unidentified pathology. Despite its use as the first-line treatment, data on acetazolamide's effectiveness and safety in pediatric idiopathic intracranial hypertension is sparse. This study's objective was to assess those issues and the need for routine blood gas monitoring during treatment. METHODS Retrospective observational cohort study, based on multicenter computerized medical charts of pediatric patients with idiopathic intracranial hypertension diagnosed between 2007-2018 in three medical centers serving one metropolitan area (an estimated population of 400,000 children). Clinical and laboratory data of children up to 18 years old, fulfilling the Friedman criteria and taking acetazolamide, were collected and analyzed. RESULTS Sixty-eight patients were included with a mean acetazolamide treatment duration of 8.5 months and a median maximal dose 18 mg/kg/d. Sixty-two children had mild (76%), moderate (13%), or severe (1.5%) metabolic acidosis. At least one adverse effect (neurologic, gastrointestinal, renal) was recorded among 27% of patients. No significant difference was found between the mean pH of children with or without clinical adverse effects (p = 0.35). No correlation was found between laboratory acidosis and adverse effect severity (p = 0.3), or between median acetazolamide dose and acidosis level (p = 0.57). CONCLUSIONS Although laboratory finding of metabolic acidosis is common among patients with idiopathic intracranial hypertension treated with acetazolamide, it is not correlated with clinics. Therefore, we recommend sending blood tests during acetazolamide treatment based on clinical judgment. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
| | - Adi Nitzan-Luques
- Pediatric Department, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
- Pediatric Hematology Oncology Department, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Aviad Schnapp
- Pediatric Department, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Noa Barnoy
- Pediatric Neurology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Shimon Reif
- Pediatric Department, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Tal Gilboa
- Pediatric Neurology Unit, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Oded Volovesky
- Pediatric Nephrology Unit and Research Lab, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
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Rogers JD, Jordan CO, Inger HE, Aylward SC. Secondary Intracranial Hypertension in Pediatric Lyme Meningitis. J Child Neurol 2023; 38:611-616. [PMID: 37691308 DOI: 10.1177/08830738231197873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Lyme disease is the most common vector-borne disease in the United States and has been associated with secondary intracranial hypertension. We reviewed 11 pediatric patients with Lyme-associated secondary intracranial hypertension. All patients presented with headache, ten had papilledema, 7 with a rash, and 5 with a cranial nerve palsy. All patients were treated with acetazolamide, and 3 received combination therapy with furosemide. Three patients were considered to have fulminant intracranial hypertension because of the severity in their presenting courses. Two of the fulminant intracranial hypertension patients were treated with a temporary lumbar drain in addition to medications, whereas 1 fulminant intracranial hypertension patient was treated exclusively with medical therapy alone. The addition of a lumbar drain decreased the time to resolution of papilledema compared to medical management alone. Final visual acuity was 20/20 in each eye of all patients, suggesting that a titrated approach to therapy depending on the severity of presentation can result in good visual outcomes in these cases. Additionally, symptoms can recur after medication wean, so patients should be monitored closely with any discontinuation of intracranial pressure lowering medications.
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Affiliation(s)
- James D Rogers
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Catherine O Jordan
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Hilliary E Inger
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Shawn C Aylward
- Department of Neurology, Nationwide Children's Hospital, Columbus, OH, USA
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Sharma M, Chhabra A, Raina N. Optic nerve sheath fenestration: A second lease at sight. Indian J Ophthalmol 2023; 71:2845-2849. [PMID: 37417132 PMCID: PMC10491070 DOI: 10.4103/ijo.ijo_3027_22] [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: 11/16/2022] [Revised: 02/27/2023] [Accepted: 03/31/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose To study the safety and efficacy of optic nerve sheath fenestration surgery in patients with optic disc edema due to different etiologies. Methods Records of 18 eyes of 15 patients who underwent optic nerve sheath fenestration for vision threatening optic disc edema were reviewed retrospectively, and results were analyzed. Improvement of visual acuity was the main measure of outcome. Improved visual fields, resolution of optic disc edema, diplopia, and headache were other benefits that were observed. Results Fifteen patients between 13 and 54 years of age were included in the study. Three patients underwent successive bilateral surgery. Idiopathic intracranial hypertension was the most common cause for optic disc edema and was found in 80% of the patients. Mean preoperative logMAR acuity was -1.9789 ± 1.46270, which improved to -0.9022 ± 1.23181 (p < 0.005) in the operated eye, and mean logMAR acuity of contralateral eye improved from -1.3378 ± 1.50107 to -1.0667 ± 1.33813 (p < 0.05). Conclusion Early optic nerve sheath fenestration is an effective modality for treating optic disc edema due to a wide myriad of causes and helps resolve the associated symptoms.
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Affiliation(s)
- Mukesh Sharma
- Medical Director, Department of Opthalmology, Centre for Sight Hospital, Jaipur, Rajasthan, India
| | | | - Nupur Raina
- Senior Resident, SMS Hospital, Jaipur, Rajasthan, India
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Kraus V, Krampe-Heni F, Steinborn M. Long-term monitoring of children with Pseudo Tumor Cerebri Syndrome by transbulbar sonography. Eur J Paediatr Neurol 2023; 44:9-17. [PMID: 36738658 DOI: 10.1016/j.ejpn.2023.01.010] [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] [Received: 07/27/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023]
Abstract
Determination of optic nerve sheath diameter (ONSD) with transbulbar sonography has become an easily accessible and time-effective tool in the assessment of increased intracranial pressure. The aim of our study was to evaluate the usefulness of transbulbar sonography in the initial diagnosis and in follow-up examinations of children and adolescents with the diagnosis of pseudotumor cerebri syndrome (PTCS). We retrospectively reviewed imaging results of 24 patients aged 0.75-17 years with PTCS. Serial transbulbar sonography examinations were performed between 2011 and 2021. Sonographic evaluation included the ONSD, papilledema and subarachnoid space. 240 sonographic measurements taken at 108 time points in 17 patients met the inclusion criteria. All patients underwent serial lumbar punctures and routine fundoscopy in close relation to transbulbar sonography. We found that ONSD values remained high in all patients. The longest follow-up period was dated 2498 days (6.84 years) after initial diagnosis. Papilledema resolved in close correlation to fundoscopy normalization. In 16/17 patients the subarachnoid space remained cystic in appearance. These findings were independent of clinical symptoms and lumbar puncture opening pressure. We conclude that transbulbar sonography is a useful diagnostic tool in the initial diagnostic workup of children with PTCS. On follow-up however ONSD values and the cystic transformation of the subarachnoid space remained pathologic in the majority of cases while papilledema resolved parallel to fundoscopy findings. Serial measurements of ONSD are therefore of limited value in the follow-up of patients with PTCS and cannot be considered a reliable tool in subsequent therapeutic decisions.
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Affiliation(s)
- V Kraus
- Technical University Munich, Department of Pediatrics, Pediatric Neurology, Kölner Platz 1, 80804, Munich, Germany; Technical University Munich, Department of Pediatrics, Chair of Social Pediatrics, Heiglhofstraße 65, 81377, Munich, Germany; Community Hospital Munich, Department of Pediatrics, Kölner Platz 1, 80804 Munich, Germany.
| | - F Krampe-Heni
- Technical University Munich, Department of Pediatrics, Pediatric Neurology, Kölner Platz 1, 80804, Munich, Germany; Community Hospital Munich, Department of Pediatrics, Kölner Platz 1, 80804 Munich, Germany
| | - M Steinborn
- Community Hospital Munich, Department of Diagnostic and Interventional Radiology and Pediatric Radiology, Kölner Platz 1, 80804, Munich, Germany
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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.
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Melendez-Zaidi AE, Foroozan R, Orman G, Abid F. COVID-19 Vaccination May Provoke Intracranial Hypertension. JOURNAL OF PEDIATRIC NEUROLOGY 2022. [DOI: 10.1055/s-0042-1750788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
AbstractIn parallel to the spread of the novel severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), there has been the growing recognition that active SARS-CoV-2 infection has the potential to effect both the peripheral and central nervous systems. When it comes to the SARS-CoV-2 vaccine, however, reporting has been more uncertain. As the vaccination rate has risen, we have seen a rise in rare neurological complications thought to be associated with the vaccination including acute transverse myelitis, Guillain–Barre syndrome, optic neuritis, and Tolosa–Hunt syndrome. The Centers for Disease Control and Prevention (CDC) estimates 98 confirmed cases of Guillain–Barre syndrome out of 12.6 million doses. Given the initial age limits of vaccination eligibility, most reports have been limited to the adult population. Here, we report a case of intracranial hypertension (IH), evolving to fulminant IH in a healthy female after receiving the SARS-CoV-2 vaccine. While elevated intracranial pressure has been reported in the context of active SARS-CoV-2 infections and postinfection multisystem inflammatory syndrome (MIS-C), this is the first reported case of pediatric IH after vaccination alone.
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Affiliation(s)
- Alexandria E. Melendez-Zaidi
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States
| | - Rod Foroozan
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, United States
| | - Gunes Orman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Texas, United States
| | - Farida Abid
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States
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[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.
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Watson I, McDonald PJ, Steinbok P, Graeber B, Singhal A. Acetazolamide to treat symptomatic ruptured arachnoid cysts: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21462. [PMID: 36303495 PMCID: PMC9379718 DOI: 10.3171/case21462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Arachnoid cysts are benign, often asymptomatic intracranial mass lesions that, when ruptured, may cause seizures, raised intracranial pressure, hemorrhage, and/or loss of consciousness. There is no widely agreed upon treatment, and there is debate as to whether a nonoperative or surgical approach is the best course of action. The carbonic anhydrase inhibitor acetazolamide may be an effective nonoperative approach in treating ruptured arachnoid cysts. OBSERVATIONS The Pediatric Neurosurgery Clinical Database at BC Children’s Hospital from 2000 to 2020 was queried, and four pediatric patients who were treated with acetazolamide after presentation with a ruptured middle cranial fossa arachnoid cyst were identified. All patients showed some degree of symptom improvement. Three of the patients showed complete reabsorption of their subdural collections in the ensuing 6 months. One patient had an inadequate response to acetazolamide and required surgical management. LESSONS Acetazolamide is a safe and reasonable primary treatment option in pediatric patients with ruptured middle cranial fossa arachnoid cysts, and it may help avoid the need for surgery.
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Affiliation(s)
- Isabella Watson
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Pediatric Neurosurgery, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Patrick J. McDonald
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Pediatric Neurosurgery, BC Children’s Hospital, Vancouver, British Columbia, Canada
- Section of Neurosurgery, University of Manitoba, Manitoba, Canada
| | - Paul Steinbok
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Pediatric Neurosurgery, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Brendon Graeber
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada; and
- Department of Radiology, BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Ashutosh Singhal
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Pediatric Neurosurgery, BC Children’s Hospital, Vancouver, British Columbia, Canada
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Yu AT, Shah SP. Idiopathic intracranial hypertension in a child with Bardet-Biedl syndrome. Ophthalmic Genet 2022; 43:534-537. [PMID: 35345964 DOI: 10.1080/13816810.2022.2050767] [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: 10/18/2022]
Abstract
BACKGROUND Bardet-Biedl syndrome (BBS) is known to be associated with hydrocephalus, but not with idiopathic intracranial hypertension (IIH). Case presentation: We describe such a case and propose the pathogenesis. We also discuss the challenges of diagnosis, treatment, and monitoring outcomes in this population that is already at high risk of vision loss from retinal dystrophy. CONCLUSION IIH can result from a combination of risk factors in conjunction with the underlying dysfunctional cilia in BBS patients. Monitoring disease progression is difficult, and as such IIH may be underdiagnosed or missed. Management must be adjusted to account for BBS patients' impaired metabolic and renal physiology. It is important that clinicians be aware of these challenges in this vulnerable population, and regular monitoring should be done to avoid preventable vision loss.
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Affiliation(s)
- Alice T Yu
- Ophthalmology Department, Queensland Children's Hospital, Brisbane, Australia
| | - Shaheen P Shah
- Ophthalmology Department, Queensland Children's Hospital, Brisbane, Australia
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Hypervitaminosis A with fulminant secondary intracranial hypertension following personalized medicine-based Elexacaftor/Tezacaftor/Ivacaftor initiation in a preadolescent with cystic fibrosis. J Cyst Fibros 2022; 21:e217-e220. [DOI: 10.1016/j.jcf.2022.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 01/12/2022] [Accepted: 01/19/2022] [Indexed: 11/17/2022]
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Rufai SR, Jeelani NUO, Bowman R, Bunce C, Proudlock FA, Gottlob I. Recognition of intracranial hypertension using handheld optical coherence tomography in children (RIO Study): a diagnostic accuracy study protocol. BMJ Open 2022; 12:e048745. [PMID: 35017232 PMCID: PMC8753392 DOI: 10.1136/bmjopen-2021-048745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Paediatric intracranial hypertension (IH) is a rare but serious condition that can pose deleterious effects on the brain and vision. Estimating intracranial pressure (ICP) in children is difficult. Gold standard direct ICP measurement is invasive and carries risk. It is impractical to routinely perform direct ICP measurements over time for all children at risk of IH. This study proposes to assess the diagnostic accuracy of handheld optical coherence tomography (OCT), a non-invasive ocular imaging method, to detect IH in children. METHODS AND ANALYSIS This is a prospective study evaluating the diagnostic accuracy of handheld OCT for IH in at risk children. Inclusion criteria include clinical and/or genetic diagnosis of craniosynostosis, idiopathic intracranial hypertension, space occupying lesion or other conditions association with IH and age 0-18 years old. Exclusion criteria include patients older than 18 years of age and/or absence of condition placing the child at risk of IH. The primary outcome measures are handheld OCT and 48-hour ICP assessments, which will be used for diagnostic accuracy testing (sensitivity, specificity, positive predictive value, negative predictive value and accuracy). Main secondary outcome measures include visual acuity, fundoscopic examination, contrast sensitivity, visual field testing and visual evoked potentials, wherever possible. ETHICS AND DISSEMINATION Ethical approval was granted for this study by the East Midlands Nottingham 2 Research Ethics committee (UOL0348/IRAS 105137). Our findings will be disseminated through presentation at relevant meetings, peer-reviewed publication and via the popular media. TRIAL REGISTRATION NUMBER ISRCTN52858719.
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Affiliation(s)
- Sohaib R Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- Ulverscroft Eye Unit, University of Leicester, Leicester, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Noor Ul Owase Jeelani
- UCL Great Ormond Street Institute of Child Health, London, UK
- Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Richard Bowman
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Catey Bunce
- Clinical Trials Unit, Royal Marsden Hospital NHS Trust, London, UK
| | | | - Irene Gottlob
- Ulverscroft Eye Unit, University of Leicester, Leicester, UK
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Al-Musalami A, Elmanzalawy A, Wali Y, Ganesh A. Secondary intracranial hypertension in aplastic anemia: A case report and review of current concepts. Oman J Ophthalmol 2021; 14:190-195. [PMID: 34880583 PMCID: PMC8597811 DOI: 10.4103/ojo.ojo_79_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/06/2021] [Accepted: 05/06/2021] [Indexed: 11/08/2022] Open
Abstract
Intracranial hypertension (IH) when detected mandates prompt and appropriate therapy to avoid permanent visual impairment. We report a 7-year-old boy who presented to the emergency services with purpuric rashes and bruises. Peripheral blood smear and bone marrow aspiration confirmed the diagnosis of aplastic anemia. During admission, the child developed headache, nausea, vomiting, and diplopia. Ophthalmic examination revealed intermittent esotropia and bilateral papilledema. The findings on neuroimaging and lumbar puncture led to the diagnosis of secondary IH (SIH). The intracranial pressure normalized on treatment with oral acetazolamide, oral furosemide, and intravenous dexamethasone.
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Affiliation(s)
- Adil Al-Musalami
- Ophthalmology Program, Oman Medical Specialty Board, Muscat, Oman
| | - Alaa Elmanzalawy
- Department of Radiology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Yasser Wali
- Department of Pediatric Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Anuradha Ganesh
- Department of Ophthalmology, Sultan Qaboos University Hospital, Muscat, Oman
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Wesley KL, Hoehn J, Butz C, Aylward SC. Experiences of Pain and Quality of Life in Pediatric Intracranial Hypertension. J Pediatr Psychol 2021; 47:412-419. [PMID: 34875076 DOI: 10.1093/jpepsy/jsab121] [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: 05/28/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To examine psychosocial correlates, specifically pain intensity, pain interference, and quality of life (QOL), in patients with pediatric intracranial hypertension. We hypothesized that parents and children who report higher levels of pain intensity and interference would be associated with lower QOL. METHODS Eighty-three patients and their families seen in the pediatric intracranial hypertension clinic of a large pediatric hospital completed self-report and parent proxy measures on QOL, mood, and other psychosocial correlates. Bivariate correlations were conducted between parent proxy and self-reports and regression analyses between pain and psychosocial correlate variables were examined. RESULTS Parent proxy and child reports were highly correlated. Body mass index (BMI) was a significant predictor of parent proxy report of pain intensity with higher BMI associated with higher parent proxy ratings of pain intensity. Parents reported significantly higher levels of pain interference for their children compared to child report. Parent ratings of child depression symptoms, BMI, and age were significant predictors of pain interference. Higher BMI and depression symptoms and younger age were associated with more pain interference. Overall QOL was similar to other headache populations but lower than other chronic illness and healthy populations. CONCLUSIONS Pediatric intracranial hypertension is associated with decreased QOL. Body mass index was a significant predictor of pain intensity and interference and should be monitored closely in clinic. Clinical care should include psychosocial screening to identify patients who would benefit from interventions to reduce the impact of this condition.
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Affiliation(s)
- Katherine L Wesley
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Colorado Anschutz Medical Campus & Children's Hospital Colorado, USA
| | - Jessica Hoehn
- Department of Psychology and Neuropsychology, Nationwide Children's Hospital, USA
| | - Catherine Butz
- Department of Psychology and Neuropsychology, Nationwide Children's Hospital, USA
| | - Shawn C Aylward
- Department of Neurology, Nationwide Children's Hospital, USA
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16
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Leventoğlu E, Büyükkaragöz B, Kenan BU, Okur A, Döğer E, Bakkaloğlu SA. A rare cause and a rare complication of hypertension in an adolescent: Answers. Pediatr Nephrol 2021; 36:4105-4108. [PMID: 34490516 DOI: 10.1007/s00467-021-05252-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Emre Leventoğlu
- Department of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey.
| | - Bahar Büyükkaragöz
- Department of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Bahriye Uzun Kenan
- Department of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Arzu Okur
- Department of Pediatric Oncology, Gazi University, Ankara, Turkey
| | - Esra Döğer
- Department of Pediatric Endocrinology, Gazi University, Ankara, Turkey
| | - Sevcan A Bakkaloğlu
- Department of Pediatric Nephrology, Faculty of Medicine, Gazi University, Ankara, Turkey
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17
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Papilledema Secondary to Neurologic Lyme Borreliosis: A Meta-Case Series. J Neuroophthalmol 2021; 41:e498-e508. [PMID: 34788244 DOI: 10.1097/wno.0000000000000983] [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 Papilledema can be a manifestation of neurologic Lyme borreliosis (LB). The clinical manifestations and progression of these cases have not been comprehensively documented to date. We aimed to describe clinical and diagnostic features and to assess patient outcomes in cases of papilledema secondary to neurologic LB. METHODS We searched MEDLINE, EMBASE, and the Cochrane Database from inception to August 2019. We did not restrict our search by study design or by publication date, status, or language. RESULTS Twenty-eight studies describing 46 cases of papilledema secondary to neurologic LB were included. Common clinical features included cranial neuropathy (68%) and diplopia (61%). Most patients did not recall tick bite (71%) and were afebrile (74%). Brain imaging was normal in 64% cases. Cerebrospinal fluid analysis showed lymphocytic pleocytosis (77%). Initial treatment with intravenous ceftriaxone was given in 52% of cases and resulted in a 100% resolution rate. Concomitant treatment with acetazolamide resulted in favorable outcomes. CONCLUSIONS For patients in endemic regions who describe symptoms suggestive of intracranial hypertension and papilledema, especially accompanied by facial nerve palsy and other cranial nerve palsies, underlying neurologic LB should be considered.
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18
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Craniosynostosis Surgery for Increased Intracranial Pressure. J Craniofac Surg 2021; 33:1454-1457. [PMID: 34732671 DOI: 10.1097/scs.0000000000008357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/07/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Craniosynostosis is the premature fusion of 1 or more cranial sutures. The presentation may vary, and there are differing opinions regarding surgical indications and timing. Though increased intracranial pressure (ICP) is a well-established risk of craniosynostosis, its response to treatment is not uniform. This study aims to identify the signs and symptoms indicative of increased ICP that are most likely to improve after craniosynostosis surgery. METHODS Pre- and post-operative data were retrospectively collected from patients at our institution with syndromic and non-syndromic craniosynostosis from January 2009 to June 2020. Demographics, symptoms (headache, nausea, emesis, and lethargy), signs (visual disturbances and papilledema), and imaging characteristics (copper beaten changes), if available, were analyzed. RESULTS One hundred fifty-three children with craniosynostosis were identified, and 56 with preoperative symptoms met inclusion criteria. Older age was significantly correlated with the number of symptoms improved postoperatively (P = 0.015). Papilledema, headache, nausea, and irritability (if present preoperatively) were the features most likely to improve after craniosynostosis repair. Optic nerve or disc anomalies, feeding difficulties, seizures, and need for glasses were least likely to improve. CONCLUSIONS Older children undergoing craniosynostosis surgery had a greater number of improved symptoms. Classical features of increased ICP were more likely to improve than developmental difficulties and multifactorial causes. These findings may be useful when considering craniosynostosis repair in a symptomatic child.
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19
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Sager G, Kaplan AT, Yalçin SÖ, Çalişkan E, Akın Y. Evaluation of the signs and symptoms of pseudotumor cerebri syndrome in pediatric population. Childs Nerv Syst 2021; 37:3067-3072. [PMID: 34263340 DOI: 10.1007/s00381-021-05279-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/29/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE Pseudotumor cerebri syndrome (PTC) is characterized by increased intracranial pressure without a space-occupying lesion and a normal cerebrospinal fluid (CSF) composition without evidence of CSF infection. In this study, we aimed to compare the symptoms, signs, and clinical characteristics of patients presenting with a preliminary diagnosis of pseudotumor cerebri syndrome (PTC) who were diagnosed and not diagnosed with PTC. METHOD We conducted a retrospective study of patients who were referred to our clinic with signs and symptoms of PTC. We compared the patients' symptoms, signs, and clinical characteristics who were diagnosed with PTC with those who were not diagnosed with PTC using modified Dandy criteria. RESULTS Ninety-four patients with the pre-diagnosis of PTC were included in the study. LP procedure was done in all patients. After LP, 75.3% of the patients were diagnosed with PTC, but 24.7% did not meet the criteria for PTC. A statistically significant relationship was found between the increase in headache complaints when leaning forward, headache that keeps the child from playing, and the CSF pressure level (p = 0.014, p = 0.019; p < 0.05). There was no statistically significant correlation between papilledema and CSF pressure level (p > 0.05). A statistically significant relationship was found between papilledema grade and CSF pressure level (p = 0.038; p < 0.05), and the rate of high CSF pressure in the groups with Grades 2-3 and Grade 4 papilledema was higher than that in the group with Grade 1 papilledema. Cranial nerve 6 palsy (CN6) (p = 0.048) and flattening of the posterior aspect of the globe (FPS) are found independent risk factors (p = 0.004 p < 0.05). CONCLUSIONS PTC signs and symptoms show variability among pediatric population.
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Affiliation(s)
- G Sager
- Department of Pediatric Neurology, Kartal Dr. Lutfi Kirdar City Hospital, Semsi Denizer Avenue, Cevizli, 34890, Kartal, Istanbul, Turkey.
| | - A T Kaplan
- Department of Ophthalmology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - S Ö Yalçin
- Department of Ophthalmology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - E Çalişkan
- Department of Radiology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Y Akın
- Department of Pediatrics, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
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20
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Ploof J, Aylward SC, Jordan CO, Drapeau AI. Case Series of Rapid Surgical Interventions in Fulminant Intracranial Hypertension. J Child Neurol 2021; 36:1047-1053. [PMID: 34259060 DOI: 10.1177/08830738211026798] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Examine ophthalmologic outcomes and complications of lumbar drain and cerebrospinal fluid shunts in pediatric fulminant intracranial hypertension. METHODS Patients under 21 years of age with a diagnosis of fulminant intracranial hypertension with temporary lumbar drain only, shunt after lumbar drain, and shunt only were included. Parameters investigated include lumbar drain data, medication freedom, time to resolution of papilledema, improvement in cranial nerve palsy, afferent pupillary defects, visual fields, visual acuity, and complications of each intervention. RESULTS Four patients had temporary lumbar drain, 2 temporary lumbar drain and cerebrospinal fluid shunt, and 3 shunt only. All achieved medication freedom and resolution of papilledema and cranial nerve palsies (if present). Most had resolution of preprocedure afferent pupillary defects. Minor residual visual field deficits occurred in 67%, and all had visual acuity improvement. One patient's lumbar drain dislodged, and one patient had 2 cerebrospinal fluid shunt revisions. CONCLUSION Temporary lumbar drain with medical therapy may be a viable first approach to fulminant intracranial hypertension.
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Affiliation(s)
- Jillian Ploof
- Department of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Shawn C Aylward
- Department of Neurology, Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University College of Medicine, Columbus, OH, USA
| | - Catherine O Jordan
- The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Ophthalmology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Annie I Drapeau
- Department of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA.,The Ohio State University College of Medicine, Columbus, OH, USA
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21
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Talukder NT, Clorfeine AH, Black MK, Moody SB. Atypical idiopathic intracranial hypertension presenting as cyclic vomiting syndrome: a case report. J Med Case Rep 2021; 15:440. [PMID: 34461990 PMCID: PMC8405252 DOI: 10.1186/s13256-021-03068-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/14/2021] [Indexed: 11/21/2022] Open
Abstract
Background Idiopathic intracranial hypertension is a disorder of increased intracranial pressure in the absence of cerebrospinal outflow obstruction, mass lesion, or other underlying cause. It is a rare phenomenon in prepubertal children and is most typically found in women of childbearing age. The classic presentation consists of headaches, nausea, vomiting, and visual changes; however, children present more atypically. We report a case of idiopathic intracranial hypertension in an otherwise healthy, 4-year-old child with atypical symptoms resembling those of cyclic vomiting syndrome. Case presentation A 4-year-old Caucasian, otherwise healthy, male child presented to our emergency department with episodic intermittent early-morning vomiting occurring once every 1–3 weeks without interepisodic symptoms, starting 10 months prior. With outpatient metabolic, autoimmune, endocrine, allergy, and gastroenterology work-up all unremarkable, he was initially diagnosed with cyclic vomiting syndrome. Discovery of mild optic nerve sheath distension on magnetic resonance imaging of the brain 10 months after symptom onset led to inpatient admission and a lumbar puncture notable for an opening pressure of 47 mmHg, with normal cell count and protein levels. He had no changes in visual acuity or optic disc edema on dilated fundoscopic examination. The patient was started on acetazolamide, with resolution of episodic emesis at his last follow-up visit 12 weeks after discharge. Conclusions Idiopathic intracranial hypertension presents atypically in prepubescent children, with about one-fourth presenting asymptomatically, and only 13–52% presenting with “classic” symptoms. With a prevalence of only 0.6–0.7 per 100,000, much remains unknown regarding the underlying pathophysiology in this demographic. Cyclic vomiting syndrome, however, has a much higher prevalence in this age group, with a prevalence of 0.4–1.9 per 100. It is thought to be an idiopathic, periodic disorder of childhood, often linked to neurological conditions such as abdominal migraines, epilepsy, mitochondrial disorders, and structural lesions such as chiari malformation and posterior fossa tumors. While cyclic vomiting syndrome is thought to have a benign course, untreated idiopathic intracranial hypertension can have long-term detrimental effects, such as visual loss or even blindness. We present a case of idiopathic intracranial hypertension presenting with symptoms resembling cyclic vomiting syndrome in a 4-year-old child, diagnosed 10 months after initial onset of symptoms. We aim to demonstrate the need for a high level of clinical suspicion and the need for further investigation into underlying pathophysiology in this vulnerable population.
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Affiliation(s)
- Nafee T Talukder
- Department of Neurology, Children's Memorial Hermann Hospital, 6410 Fannin St., Ste 1014, Houston, TX, 77030, USA. .,University of Texas Health Science Center, Houston, TX, USA.
| | - Amanda H Clorfeine
- Department of Neurology, Children's Memorial Hermann Hospital, 6410 Fannin St., Ste 1014, Houston, TX, 77030, USA.,University of Texas Health Science Center, Houston, TX, USA
| | - Moira K Black
- Department of Neurology, Children's Memorial Hermann Hospital, 6410 Fannin St., Ste 1014, Houston, TX, 77030, USA.,University of Texas Health Science Center, Houston, TX, USA
| | - Shade B Moody
- Department of Neurology, Children's Memorial Hermann Hospital, 6410 Fannin St., Ste 1014, Houston, TX, 77030, USA.,University of Texas Health Science Center, Houston, TX, USA
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22
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Non-traumatic pediatric intracranial hypertension: key points for different etiologies, diagnosis, and treatment. Acta Neurol Belg 2021; 121:823-836. [PMID: 33829371 DOI: 10.1007/s13760-021-01626-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/02/2021] [Indexed: 12/30/2022]
Abstract
Intracranial hypertension can be an acute life-threatening event or slowly deteriorating condition, leading to a gradual loss of neurological function. The diagnosis should be taken in a timely fashioned process, which mandates expedite measures to save brain function and sometimes life. An optimal management strategy is selected according to the causative etiology with a core treatment paradigm that can be utilized in various etiologies. Distinct etiologies are intracranial bleeds caused by traumatic brain injury, spontaneous intracranial hemorrhage (e.g., neonatal intraventricular hemorrhage), or the rare pediatric hemorrhagic stroke. The other primary pediatric etiologies for elevated intracranial pressure are intracranial mass (e.g., brain tumor) and hydrocephalus related. Other unique etiologies in the pediatric population are related to congenital diseases, infectious diseases, metabolic or endocrine crisis, and idiopathic intracranial pressure. One of the main goals of treatment is to alleviate the growing pressure and prevent the secondary injury to brain parenchyma due to inadequate blood perfusion and eventually inadequate parenchymal oxygenation and metabolic state. Previous literature discussed essential characteristics of the treatment paradigm derived mainly from pediatric brain traumatic injuries' treatment methodology. Yet, many of these etiologies are not related to trauma; thus, the general treatment methodology must be tailored carefully for each patient. This review focuses on the different possible non-traumatic etiologies that can lead to intracranial hypertension with the relevant modification of each etiology's treatment paradigm based on the current literature.
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23
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Dotan G, Hadar Cohen N, Qureshi HM, Shapira Rootman M, Nevo Y, Kershenovich A. External lumbar drainage in progressive pediatric idiopathic intracranial hypertension. J Neurosurg Pediatr 2021; 28:490-496. [PMID: 34271543 DOI: 10.3171/2021.2.peds2143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/19/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pediatric idiopathic intracranial hypertension (IIH) is characterized by increased intracranial pressure despite normal cerebrospinal fluid and neuroimaging findings. Initial management is typically medical; however, nearly 10% of children will eventually require surgery for persistent headache and/or vision loss. External lumbar drainage, which is a considerably safer treatment option, has not been adequately analyzed in children with medically refractory IIH. METHODS The authors conducted a single-institution retrospective analysis of children with medically refractory IIH who had undergone external lumbar drain (ELD) placement because of worsening papilledema, reflected as increased retinal nerve fiber layer (RNFL) thickness on optical coherence tomography (OCT) testing. The main outcome measures were effects of external lumbar drainage on papilledema resolution, symptoms, and vision. RESULTS The authors analyzed the medical records of 13 children with IIH (11 girls, mean age 15.0 ± 2.3 years) whose mean CSF opening pressure was 45.5 ± 6.8 cm H2O. In all children, the average global RNFL thickness in both eyes significantly increased at ELD placement (right eye 371.8 ± 150.2 μm, left eye 400.3 ± 96.9 μm) compared with presentation thickness (right eye 301.6 ± 110.40 μm, left eye 350.2 ± 107.7 μm) despite acetazolamide medical therapy (20-30 mg/kg/day), leading to ELD placement after 9.5 ± 6.9 days (range 3-29 days). After ELD insertion, there was headache resolution, gradual and continuous improvement in optic disc thickness, and preservation of good vision. CONCLUSIONS ELD placement in children with medically refractory IIH who demonstrated worsening papilledema with increased RNFL thickening on OCT testing typically results in symptom relief and disc edema resolution with good visual outcome, often preventing the need for additional definitive surgeries that carry greater failure and morbidity risks.
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Affiliation(s)
- Gad Dotan
- 1Pediatric-Ophthalmology Unit, Schneider Children's Medical Center of Israel, Petah Tikva.,2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv
| | - Natalie Hadar Cohen
- 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv.,3Ophthalmology Division, Rabin Medical Center, Petah Tikva, Israel
| | - Hanya M Qureshi
- 4Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Mika Shapira Rootman
- 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv.,5Department of Radiology
| | - Yoram Nevo
- 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv.,6Institute of Child Neurology; and
| | - Amir Kershenovich
- 7Division of Pediatric Neurosurgery, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
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24
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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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25
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Rootman MS, Dotan G, Konen O. Neuroimaging in Children with Ophthalmological Complaints: A Review. J Neuroimaging 2021; 31:446-458. [PMID: 33615595 DOI: 10.1111/jon.12842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/27/2022] Open
Abstract
Pediatric patients are commonly referred to imaging following abnormal ophthalmological examinations. Common indications include papilledema, altered vision, strabismus, nystagmus, anisocoria, proptosis, coloboma, and leukocoria. Magnetic resonance imaging (MRI) of the brain and orbits (with or without contrast material administration) is typically the imaging modality of choice. However, a cranial CT scan is sometimes initially performed, particularly when MRI is not readily available. Familiarity with the various ophthalmological conditions may assist the radiologist in formulating differential diagnoses and proper MRI protocols afterward. Although MRI of the brain and orbits usually suffices, further refinements are sometimes warranted to enable suitable assessment and accurate diagnosis. For example, the assessment of children with sudden onset anisocoria associated with Horner syndrome will require imaging of the entire oculosympathetic pathway, including the brain, orbits, neck, and chest. Dedicated orbital scans should cover the area between the hard palate and approximately 1 cm above the orbits in the axial plane and extend from the lens to the midpons in the coronal plane. Fat-suppressed T2-weighted fast spin echo sequences should enable proper assessment of the globes, optic nerves, and perioptic subarachnoid spaces. Contrast material should be given judiciously, ideally according to clinical circumstances and precontrast scans. In this review, we discuss the major indications for imaging following abnormal ophthalmological examinations.
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Affiliation(s)
- Mika Shapira Rootman
- Department of Radiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University
| | - Gad Dotan
- Ophthalmology Unit, Schneider Children's Medical center of Israel, Petac Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University
| | - Osnat Konen
- Department of Radiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University
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26
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Raucci U, Borrelli O, Di Nardo G, Tambucci R, Pavone P, Salvatore S, Baldassarre ME, Cordelli DM, Falsaperla R, Felici E, Ferilli MAN, Grosso S, Mallardo S, Martinelli D, Quitadamo P, Pensabene L, Romano C, Savasta S, Spalice A, Strisciuglio C, Suppiej A, Valeriani M, Zenzeri L, Verrotti A, Staiano A, Villa MP, Ruggieri M, Striano P, Parisi P. Cyclic Vomiting Syndrome in Children. Front Neurol 2020; 11:583425. [PMID: 33224097 PMCID: PMC7667239 DOI: 10.3389/fneur.2020.583425] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022] Open
Abstract
Cyclic Vomiting Syndrome (CVS) is an underdiagnosed episodic syndrome characterized by frequent hospitalizations, multiple comorbidities, and poor quality of life. It is often misdiagnosed due to the unappreciated pattern of recurrence and lack of confirmatory testing. CVS mainly occurs in pre-school or early school-age, but infants and elderly onset have been also described. The etiopathogenesis is largely unknown, but it is likely to be multifactorial. Recent evidence suggests that aberrant brain-gut pathways, mitochondrial enzymopathies, gastrointestinal motility disorders, calcium channel abnormalities, and hyperactivity of the hypothalamic-pituitary-adrenal axis in response to a triggering environmental stimulus are involved. CVS is characterized by acute, stereotyped and recurrent episodes of intense nausea and incoercible vomiting with predictable periodicity and return to baseline health between episodes. A distinction with other differential diagnoses is a challenge for clinicians. Although extensive and invasive investigations should be avoided, baseline testing toward identifying organic causes is recommended in all children with CVS. The management of CVS requires an individually tailored therapy. Management of acute phase is mainly based on supportive and symptomatic care. Early intervention with abortive agents during the brief prodromal phase can be used to attempt to terminate the attack. During the interictal period, non-pharmacologic measures as lifestyle changes and the use of reassurance and anticipatory guidance seem to be effective as a preventive treatment. The indication for prophylactic pharmacotherapy depends on attack intensity and severity, the impairment of the QoL and if attack treatments are ineffective or cause side effects. When children remain refractory to acute or prophylactic treatment, or the episode differs from previous ones, the clinician should consider the possibility of an underlying disease and further mono- or combination therapy and psychotherapy can be guided by accompanying comorbidities and specific sub-phenotype. This review was developed by a joint task force of the Italian Society of Pediatric Gastroenterology Hepatology and Nutrition (SIGENP) and Italian Society of Pediatric Neurology (SINP) to identify relevant current issues and to propose future research directions on pediatric CVS.
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Affiliation(s)
- Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, University College London (UCL) Institute of Child Health and Great Ormond Street Hospital, London, United Kingdom
| | - Giovanni Di Nardo
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Piero Pavone
- Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Silvia Salvatore
- Pediatric Department, Ospedale “F. Del Ponte,” University of Insubria, Varese, Italy
| | | | | | - Raffaele Falsaperla
- Neonatal Intensive Care and Pediatric Units, S. Marco Hospital, Vittorio Emanuele Hospital, Catania, Italy
| | - Enrico Felici
- Unit of Pediatrics, The Children Hospital, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Michela Ada Noris Ferilli
- Division of Neurology, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Saverio Mallardo
- Pediatric Department, Santa Maria Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Diego Martinelli
- Division of Metabolism, Department of Pediatric Specialties, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Paolo Quitadamo
- Department of Pediatrics, A.O.R.N. Santobono-Pausilipon, Naples, Italy
| | - Licia Pensabene
- Pediatric Unit, Department of Medical and Surgical Sciences, University “Magna Graecia” of Catanzaro, Catanzaro, Italy
| | - Claudio Romano
- Pediatric Gastroenterology Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
| | | | - Alberto Spalice
- Child Neurology Division, Department of Pediatrics, “Sapienza,” University of Rome, Rome, Italy
| | - Caterina Strisciuglio
- Department of Woman, Child, General and Specialistic Surgery, University of Campania “Luigi Vanvitelli,” Naples, Italy
| | - Agnese Suppiej
- Pediatric Section, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Massimiliano Valeriani
- Division of Neurology, Bambino Gesù Children's Hospital, Institute for Research, Hospitalization and Health Care (IRCCS), Rome, Italy
| | - Letizia Zenzeri
- Emergency Pediatric Department, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L'Aquila, L'Aquila, Italy
| | - Annamaria Staiano
- Section of Pediatrics, Department of Translational Medical Science, “Federico II” University of Naples, Naples, Italy
| | - Maria Pia Villa
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Section of Pediatrics and Child Neuropsychiatry, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
- Institute for Research, Hospitalization and Health Care (IRCCS) “G. Gaslini” Institute, Genova, Italy
| | - Pasquale Parisi
- Chair of Pediatrics, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Genizi J, Mahajnah M. Pseudotumor Cerebri Syndrome in Young Children: What Is the Difference From Adults? J Child Neurol 2020; 35:941. [PMID: 32631123 DOI: 10.1177/0883073820935727] [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: 11/15/2022]
Affiliation(s)
- Jacob Genizi
- Child Neurology Unit, Bnai-Zion Medical Center, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Muhammad Mahajnah
- Child Neurology and Development Center, 26736Hillel-Yaffe Medical Center, Hadera, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Intracranial Hypertension and Papilledema in a Large Cohort of Pediatric Patients With Alagille Syndrome. J Pediatr Gastroenterol Nutr 2020; 71:655-662. [PMID: 33093373 DOI: 10.1097/mpg.0000000000002883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
AIMS AND BACKGROUND Ophthalmic abnormalities are amongst the 5 major criteria required for a diagnosis of Alagille syndrome (ALGS), of which embryotoxon, pseudopapilledema, and hypopigmented retinopathy are the most common. Papilledema with or without intracranial hypertension (ICHT) is rarely described. We report 9 pediatric cases of ALGS with bilateral papilledema, 5 of which were diagnosed with ICHT. METHODS The ophthalmic data from 85 patients with clinically and/or genetically (n = 37) proven ALGS were reviewed. The study inclusion criteria were a positive diagnosis of ALGS and availability of ophthalmic follow-up data. Ophthalmic data from 40 patients after liver transplantation (LT) for other indications were also analyzed. RESULTS Nine (13.0%) of the 69 patients meeting the inclusion criteria had papilledema. The neurological and neuroimaging results in all 9 patients were normal. These 9 patients were categorized into 4 groups: a nontransplant group (n = 1), a group with pretransplant papilledema persistent after LT (n = 2), a group with papilledema occurring after LT with spontaneous resolution (n = 1), and a group with papilledema and signs of ICHT after LT (n = 5). The patients with ICHT were treated with steroids alone (n = 1) or with acetazolamide (n = 4). A ventriculoperitoneal shunt was placed in 2 of the 5 cases because of progressive visual loss. Pseudopapilledema was present in 10 additional patients (14.5%, 10/69). One (2.5%) of the 40 patients without ALGS developed papilledema after LT. CONCLUSIONS True ICHT may be underdiagnosed in patients with ALGS. Our findings underscore the need for close ophthalmic follow-up before and after LT in these patients.
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Rogers DL, Akoghlanian S, Reem RE, Rogers S, Aylward SC. Secondary Intracranial Hypertension in Pediatric Patients With Cryopyrin-Associated Periodic Syndrome. Pediatr Neurol 2020; 111:70-72. [PMID: 32951665 DOI: 10.1016/j.pediatrneurol.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cryopyrin-associated periodic syndrome is characterized by periodic fever, rash, and joint pain. Papilledema rarely occurs. We present our series of patients with cryopyrin-associated periodic syndrome who clinically met the diagnostic criteria for Muckle-Wells syndrome and our experience with secondary intracranial hypertension. METHODS Retrospective review of all patients with cryopyrin-associated periodic syndrome at Nationwide Children's Hospital from October 2015 to September 2017. RESULTS Eighteen children met inclusion criteria: 15 females and three males, aged 1.5 to 16.2 years. Fifteen had periodic fever genetic testing; three had a known genetic defect identified, eight had a defect identified not currently known to be associated with cryopyrin-associated periodic syndrome, and four had no defect identified. Six patients (30%) developed headaches and were diagnosed with secondary intracranial hypertension. Lumbar puncture opening pressures ranged from 28 to 45 cm H2O. Only one patient had papilledema. Initial treatment was medical in all cases, by increasing interleukin-1 inhibitor dose and/or acetazolamide. One patient required a ventriculoperitoneal shunt for headache management. No visual acuity loss was detected. All six patients with secondary intracranial hypertension had a known genetic mutation or genetic variant of unknown significance; five involved the NLRP3 gene. CONCLUSIONS In our series of 18 patients with cryopyrin-associated periodic syndrome, secondary intracranial hypertension occurred at a higher than expected rate. We suspect that genetic defects involving the NLRP3 gene may be a risk factor. Papilledema was present in only one patient. Physicians treating cryopyrin-associated periodic syndrome should be aware of this vision-threatening association and potential therapeutic approach.
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Affiliation(s)
- David L Rogers
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio.
| | | | - Rachel E Reem
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio
| | - Sage Rogers
- Department of Psychology, Brigham Young University, Provo, Utah
| | - Shawn C Aylward
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio
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Monteu F, D'Alonzo G, Nuzzi R. Pediatric Pseudotumor Cerebri: Epidemiological Features. Open Ophthalmol J 2020. [DOI: 10.2174/1874364102014010047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective:
The purpose was to study the epidemiological and clinical features of Pediatric Pseudotumor Cerebri; we especially evaluated age, sex, sexual maturity, weight, symptoms, duration of the episode, visual acuity, correlation with systemic diseases or drugs.
Methods:
We investigated a population of 40 children (80 eyes), aged between 2 and 18 years, that referred to our Centre (Città della Salute e della Scienza di Torino - presidio Ospedale Regina Margherita) from 2000 to 2018.
All the patients were monitored with visual field exam, fundus exam and Frisen classification, pupillary reflexes, best corrected visual acuity, orthoptic exam.
Then, the demographic characteristics, BMI (body max index) and weight changes, the correlation with systemic diseases or drugs, the Relative Afferent Pupillary Defect (RAPD), the VI cranial nerve deficit, the time required for the diagnosis, the modality of onset, the correlation between diagnosis delay and best corrected visual acuity, the resolution time and the probability of recurrence were studied.
Results:
We observed 2 age peaks in our population, one consisting of adolescents (aged between 11 and 14 years) and one consisting of younger children aged between 4 and 7 years, with a statistically significant correlation between age and BMI.
The deficit of the VI cranial nerve and the diplopia were resolved within the first month, despite the longer time of resolution of the papilledema.
Headache was the main onset symptom, but after reclassifying onset symptoms per weight classes, in overweight children, we found an increased variability of symptoms (dizziness, postural instability, photophobia, nausea, vomit, strabism and diplopia, visual fogging, drowsiness, irritability). Moreover, we found only one totally asymptomatic case, during a routine visit, in a 6 years old overweight child with Down syndrome.
Conclusion:
The Pediatric Pseudotumor Cerebri is, even nowadays, a little known pathology.
To provide a correct diagnostic assessment, it will be imperative to recollect the epidemiological features of this disease.
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Lee KE, Zehri A, Soldozy S, Syed H, Catapano JS, Maurer R, Albuquerque FC, Liu KC, Wolfe SQ, Brown S, Levitt MR, Fargen KM. Dural venous sinus stenting for treatment of pediatric idiopathic intracranial hypertension. J Neurointerv Surg 2020; 13:465-470. [PMID: 32732257 DOI: 10.1136/neurintsurg-2020-016183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/25/2020] [Accepted: 07/02/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Dural venous sinus stenting (VSS) is an effective treatment for idiopathic intracranial hypertension (IIH) in adult patients. There are no published series to date evaluating safety and efficacy of VSS in pediatric patients. OBJECTIVE To report on procedural device selection and technique as well as safety and efficacy of VSS for pediatric patients with medically refractory IIH due to underlying venous sinus stenosis. METHODS A multi-institutional retrospective case series identified patients with medically refractory IIH aged less than 18 years who underwent VSS. RESULTS 14 patients were identified at four participating centers. Patient ages ranged from 10 to 17 years, and 10 patients (71.4%) were female. Mean body mass index was 25.7 kg/m2 (range 15.8-34.6 kg/m2). Stenting was performed under general endotracheal anesthesia in all except two patients. The average trans-stenotic gradient during diagnostic venography was 10.6 mm Hg. Patients had stents placed in the superior sagittal sinus, transverse sinus, sigmoid sinus, occipital sinus, and a combination. Average follow-up was 1.7 years after stenting. Six patients out of 10 (60%) had reduced medication dosing, 12 of 14 patients (85.7%) had improvements in headaches, two patients (100%) with pre-stent tinnitus had resolution of symptoms, and four (80%) of five patients with papilledema had improvement on follow-up ophthalmological examinations. Two patients (14.3%) developed postprocedural groin hematomas, one patient (7.1%) developed a groin pseudoaneurysm, and one patient (7.1%) had postprocedural groin bleeding. No other procedural complications occurred. Four patients (28.6%) required further surgical treatment (cerebrospinal shunting and/or stenting) after their first stenting procedure. CONCLUSIONS This series suggests that VSS is feasible in a pediatric population with IIH and has a low complication rate and good clinical outcomes.
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Affiliation(s)
- Katriel E Lee
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Aqib Zehri
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Sauson Soldozy
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Hasan Syed
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia, USA
| | - Joshua S Catapano
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Robert Maurer
- Penn State Health Neurosurgery, Hershey, Pennsylvania, USA
| | - Felipe C Albuquerque
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Kenneth C Liu
- Department of Neurological Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Stacey Q Wolfe
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
| | - Sandra Brown
- Cabarrus Eye Center, Concord, North Carolina, USA
| | - Michael R Levitt
- Department of Neurological Surgery, Radiology and Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Kyle M Fargen
- Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA
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Kornbluh AB, Thompson K, Mcmahen G, Rogers DL, Jordan CO, Aylward SC, Lehwald LM. Sleep disturbance in pediatric intracranial hypertension. J Clin Sleep Med 2020; 16:1099-1105. [DOI: 10.5664/jcsm.8436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Gada Mcmahen
- Department of Neurology, Nationwide Children’s Hospital, Columbus, Ohio
| | - David L. Rogers
- Department of Ophthalmology, Nationwide Children’s Hospital, Columbus, Ohio
| | | | - Shawn C. Aylward
- Department of Neurology, Nationwide Children’s Hospital, Columbus, Ohio
| | - Lenora M. Lehwald
- Department of Neurology and Sleep Medicine, Nationwide Children’s Hospital, Columbus, Ohio
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Rufai SR, Jeelani NUO, McLean RJ. Detection of intracranial hypertension in children using optical coherence tomography: a systematic review protocol. BMJ Open 2020; 10:e037833. [PMID: 32636287 PMCID: PMC7342863 DOI: 10.1136/bmjopen-2020-037833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Intracranial hypertension (ICH) in children can have deleterious effects on the brain and vision. It is notoriously difficult to estimate intracranial pressure (ICP) in children and existing methods deliver suboptimal diagnostic accuracy to be used as screening tools. Optical coherence tomography (OCT) may represent a valuable, non-invasive surrogate measure of ICP, as has been demonstrated in a number of associated conditions affecting adults. More recently, OCT has been employed within the paediatric age group. However, the role of OCT in detecting ICH in children has not been rigorously assessed in a systematic review for all relevant conditions. Here, we propose a systematic review protocol to examine the role of OCT in the detection of ICH in children. METHODS AND ANALYSIS Electronic searches in the Cochrane Central Register of Controlled Trials, Medline, Embase, Web of Science and PubMed will identify studies featuring OCT in detecting ICH in children. Two independent screeners will identify studies for inclusion using a screening questionnaire. The systematic search and screening will take place between 2 April 2020 and 1 June 2020, while we aim to complete data analysis by 1 September 2020. Quality assessment will be performed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The primary outcome measure is the sensitivity and specificity of OCT in detecting ICH in children. Secondary outcomes measures include conditions associated with ICH per study, direct ICP monitoring, sensitivity and specificity of other measures for ICP and OCT parameters used. ETHICS AND DISSEMINATION Ethical approval is not required for the proposed systematic review as no primary data will be collected. The findings will be disseminated through presentations at scientific meetings and peer-reviewed journal publication. PROSPERO REGISTRATION NUMBER CRD42019154254.
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Affiliation(s)
- Sohaib R Rufai
- Clinical and Academic Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, United Kingdom
| | - Noor Ul Owase Jeelani
- Craniofacial Unit, Great Ormond Street Hospital for Children, London, United Kingdom
- Developmental Biology & Cancer Dept, UCL GOS Institute of Child Health, London, United Kingdom
| | - Rebecca J McLean
- University of Leicester Ulverscroft Eye Unit, Leicester Royal Infirmary, Leicester, United Kingdom
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Lalou AD, Czosnyka M, Garnett MR, Nabbanja E, Petrella G, Hutchinson PJ, Pickard JD, Czosnyka Z. Shunt infusion studies: impact on patient outcome, including health economics. Acta Neurochir (Wien) 2020; 162:1019-1031. [PMID: 32078047 PMCID: PMC7156359 DOI: 10.1007/s00701-020-04212-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 01/06/2020] [Indexed: 12/03/2022]
Abstract
Objectives The diagnosis of shunt malfunction is often not straightforward. We have explored, in symptomatic shunted patients with hydrocephalus or pseudotumour cerebri syndrome (PTCS), the accuracy of CSF infusion tests in differentiating a functioning shunt from one with possible problems, and the health economic consequences. Methods Participants: hydrocephalus/PTCS patients with infusion tests performed from January 2013 until December 2015. We followed patients up after 6 and 12 months from the test to determine whether they had improved, had persisting symptoms or had required urgent revision. We calculated the total cost savings of revision versus infusion tests and standard protocol of revision and ICP monitoring versus infusion tests. Results Three hundred sixty-five shunt infusion tests had been performed where a shunt prechamber/reservoir was present. For hydrocephalus patients, more than half of the tests (~ 55%, 155 out of 280) showed no shunt malfunction versus 125 with possible malfunction (ages 4 months to 90 years old). For PTCS patients aged 10 to 77 years old, 47 had possible problems and 38 no indication for shunt malfunction. Overall, > 290 unnecessary revisions were avoided over 3 years’ time. Two hundred fifty-eight (> 85%) of those non-surgically managed, remained well, did not deteriorate and did not require surgery. No infections were associated with infusion studies. For Cambridge, the overall savings from avoiding revisions was £945,415 annually. Conclusions Our results provide evidence of the importance of shunt testing in vivo to confirm shunt malfunction. Avoiding unnecessary shunt revisions carries a strong health benefit for patients that also translates to a significant financial benefit for the National Health Service and potentially for other healthcare systems worldwide. Electronic supplementary material The online version of this article (10.1007/s00701-020-04212-0) contains supplementary material, which is available to authorized users.
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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.
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Affiliation(s)
- Muhammad Mahajnah
- Child Neurology and Development Center, Hillel-Yaffe Medical Center, Hadera, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Jacob Genizi
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Child Neurology Unit, Bnai-Zion Medical Center, Haifa, Israel
| | - Hazar Zahalka
- Child Neurology and Development Center, Hillel-Yaffe Medical Center, Hadera, Israel
| | - Ronza Andreus
- Child Neurology and Development Center, Carmel Medical Center & Clalit Health Services, Haifa District, Israel
| | - Nathanel Zelnik
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.,Child Neurology and Development Center, Carmel Medical Center & Clalit Health Services, Haifa District, Israel
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Dsouza S, Aylward BS, Rogers DL, Aylward SC. Presenting Symptomatology and Risk Factors in Pediatric Secondary Intracranial Hypertension due to Venous Sinus Thrombosis. Pediatr Neurol 2019; 101:53-56. [PMID: 31601452 DOI: 10.1016/j.pediatrneurol.2019.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 03/22/2019] [Accepted: 04/21/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND There remains debate regarding the need for venous imaging in pediatric intracranial hypertension. METHODS Records of patients aged 18 years or younger who were evaluated in the intracranial hypertension clinic at Nationwide Children's Hospital in Columbus, Ohio, were reviewed. Past medical history, diagnostic evaluation, and presenting symptoms were examined to evaluate differences in symptomatology presentation and risk factors in patients with pediatric intracranial hypertension with and without thrombosis. RESULTS A total of 226 patients met inclusion criteria, 145 were diagnosed with primary intracranial hypertension, 81 with secondary intracranial hypertension, with 17 noted to have venous sinus thrombosis as the cause of their secondary intracranial hypertension. Of those with thrombosis, 41.2% did not have any thrombosis risk factors. Headache was the most prominent symptom, present in 73.8% (n = 107) of patients with primary intracranial hypertension, 87.5% (n = 56) of patients with secondary intracranial hypertension without thrombosis, and 82.4% (n = 14) with thrombosis. CONCLUSIONS The only clinically significant difference in presenting symptomatology between the thrombosis and the other groups was nausea or vomiting. Predisposing factors to develop thrombosis were absent in 41.2% of patients. Hence, the need for venous imaging in pediatric intracranial hypertension cannot be clearly determined by clinical presentation or risk factors alone. Patients with indwelling catheters should receive imaging in the region of their catheter to rule out catheter-associated thrombosis.
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Affiliation(s)
- Shalome Dsouza
- Department of Neurology, University of South Dakota Sanford School of Medicine, Vermillion, South Dekota
| | | | - David L Rogers
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio
| | - Shawn C Aylward
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio.
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Hilely A, Hecht I, Goldenberg-Cohen N, Leiba H. Long-Term Follow-up of Pseudotumor Cerebri Syndrome in Prepubertal Children, Adolescents, and Adults. Pediatr Neurol 2019; 101:57-63. [PMID: 31604646 DOI: 10.1016/j.pediatrneurol.2019.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/12/2019] [Accepted: 04/21/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Pseudotumor cerebri syndrome can have a recurrent course. We compared the long-term disease course, recurrences, and final visual outcomes in prepubertal children, adolescents, and adults. METHODS In this retrospective observational study, patients were divided into prepubertal children (group A) adolescents (group B), and adults (group C). RESULTS Sixty-five patients (56 females, nine males) were included, 26.2% in group A, 24.6% in group B, and 49.2% in group C. Age at diagnosis was 8.6 ± 2.0 years, 14.3 ± 1.5 years, and 31.9 ± 9.7 years for the prepubertal children, adolescents, and adults, respectively. Medical treatment duration was similar (2.4 to 3.3 years, P > 0.05). Recurrences were observed in 23.5% of prepubertal children, 50% of adolescents, and 28.1% of adults. Recurrences occurred within 1.3 ± 0.6 years from treatment cessation in the prepubertal group compared with 3.8 ± 5.1 years in adolescents and 2.7 ± 2.0 years in adults (P = 0.267). Optic neuropathy was evident in 41% of group A, 31% of group B, and 87.5% of group C (P < 0.001). Obesity and cerebrospinal fluid opening pressures were unassociated with either relapsing rates or final visual outcomes in all groups. CONCLUSIONS Pseudotumor cerebri syndrome exhibits a relapsing course in a third of cases. Recurrences tend to occur within one year after treatment cessation in prepubertal children, and within three years in older patients, revealing the importance of longer follow-up, especially in adults. Optic neuropathy was more common in adults along with a tendency for visual decline. Longer treatment times were associated with fewer recurrences.
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Affiliation(s)
- Assaf Hilely
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel; The Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Idan Hecht
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nitza Goldenberg-Cohen
- Department of Ophthalmology, Bnai Zion Medical Center, Haifa, Israel; Krieger Eye Research Laboratory, Felsenstein Medical Research Center, Tel Aviv University, Rabin Campus, Petach Tikva, Israel; The Bruce and Ruth Rappaport, Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Hana Leiba
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel; The Hebrew University of Jerusalem, Jerusalem, Israel
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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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Abstract
PURPOSE OF REVIEW Pseudotumor cerebri syndrome (PTCS) may affect both children and adults; however, the risk factors and clinical presentation vary greatly between these populations. This review aims to highlight the entity of PTCS in children and the unique considerations in this population; review the epidemiology and demographics; discuss the clinical presentation, revised diagnostic criteria, and approach to evaluation; review management strategies; and discuss the prognosis and long-term outcomes in children with PTCS. RECENT FINDINGS Clinical presentation can be variable in children and may be less obvious than in their adult counterparts. Papilledema can also be challenging to diagnose in this population. The upper limits for opening pressure on lumbar puncture differ in children, with a cut-off of 25 cm H20 (or 28 cm H2O in a sedated or obese child). Morbidity related to visual loss, pain and reduced quality of life lends urgency towards accurately identifying, evaluating and managing children with PTCS. There are no randomised controlled studies to allow for evidence-based recommendations for the management of PTCS in children. Further studies are needed to clarify and consolidate management approaches in this population.
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Affiliation(s)
- Rebecca Barmherzig
- Division of Neurology, Women's College Hospital Centre for Headache, University of Toronto, Toronto, Canada.,Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Christina L Szperka
- Pediatric Headache Program, Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, CTRB 10019 3501 Civic Center Blvd., Philadelphia, PA, 19104, USA.
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Inger HE, McGregor ML, Jordan CO, Reem RE, Aylward SC, Scoville NM, Bai S, Rogers DL. Surgical intervention in pediatric intracranial hypertension: incidence, risk factors, and visual outcomes. J AAPOS 2019; 23:96.e1-96.e7. [PMID: 30826384 DOI: 10.1016/j.jaapos.2018.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/12/2018] [Accepted: 11/18/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the incidence of surgical intervention in pediatric intracranial hypertension (IH), evaluate the visual outcomes of surgically managed patients, and identify potential predictors for surgical intervention. METHODS The medical records of patients with primary and secondary IH at Nationwide Children's Hospital from 2010 to 2017 were reviewed retrospectively. Presenting characteristics of medically and surgically managed patients were compared, and the clinical courses of surgically managed patients were reviewed. RESULTS A total of 129 medically and 14 surgically managed patients were included. The surgical incidence was 9.8%. Final visual acuity in 27 of 28 surgically managed eyes was 20/25 or better. In combined primary and secondary IH patients, elevations in body mass index (BMI; OR = 1.06; 95% CI, 1.01-1.11; P = 0.022) and lumbar puncture opening pressures ≥52 cm H2O (OR = 6.17; 95% CI, 1.93-19.67; P = 0.002) were significantly associated with the likelihood of surgical intervention when assessed by univariate logistic regression; grade of papilledema >2 was of marginal significance. After controlling for BMI, a lumbar puncture opening pressure of ≥52 cm H2O was more likely to result in surgery (adjusted OR = 4.69; 95% CI = 1.39-15.98; P = 0.013). CONCLUSIONS Most pediatric IH can be treated medically. Patients with lumbar puncture opening pressures ≥52 cm H2O at the time of diagnosis are at a higher risk of surgical intervention and should be monitored closely. Elevations in presenting BMI and grade of papilledema may also increase the odds of surgery.
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Affiliation(s)
- Hilliary E Inger
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio; Department of Ophthalmology, The Ohio State University, Columbus, Ohio
| | - Mary Lou McGregor
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio
| | - Catherine O Jordan
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio
| | - Rachel E Reem
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio
| | - Shawn C Aylward
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Shasha Bai
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, Ohio
| | - David L Rogers
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio.
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Maffeis L, Dilena R, Guez S, Menni F, Bana C, Osnaghi S, Carrabba G, Marchisio P. Pseudotumour cerebri associated with mycoplasma pneumoniae infection and treatment with levofloxacin: a case report. BMC Pediatr 2019; 19:4. [PMID: 30611233 PMCID: PMC6320575 DOI: 10.1186/s12887-018-1371-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 12/13/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH), also known as pseudotumour cerebri syndrome (PTCS), is characterized by the presence of signs and symptoms of raised intracranial pressure without evidence of any intracranial structural cause and with normal cerebrospinal fluid microscopy and biochemistry. Obesity, various systemic diseases and endocrine conditions, and a number of medications are known to be risk factors for PTCS. The medications commonly associated with PTCS are amiodarone, antibiotics, corticosteroids, cyclosporine, growth hormone, oral contraceptives, vitamin A analogues, lithium, phenytoin, NSAIDs, leuprolide acetate, and some neuroleptic drugs. In relation to antibiotics, quinolones may cause intracranial hypertension, and most reported cases of quinolone-induced intracranial hypertension were associated with nalidixic acid, ciprofloxacin, ofloxacin, or pefloxacin. Literature reports of levofloxacin-induced PTCS are rare. Some authors recently hypothesized that Mycoplasma pneumoniae may trigger PTCS. CASE PRESENTATION We report on a 14-year-old overweight White Italian boy who suffered headache, diplopia, and severe bilateral papilloedema after a Mycoplasma pneumoniae infection, exacerbated on levofloxacin intake. A spontaneous improvement in headache and a reduction in diplopia was seen during hospitalisation. Oral acetazolamide therapy led to the regression of papilloedema in about five months. No permanent eye damage has been observed in our patient to date. CONCLUSIONS PTCS pathophysiology may be multifactorial and its specific features and severity may be a consequence of both constitutional and acquired factors interacting synergistically. It may be useful for paediatricians to know that some antibiotics may have the potential to precipitate PTCS in patients who already have an increased CSF pressure due to a transitory imbalanced CSF circulation caused by infections such as Mycoplasma pneumoniae, with headache being the first and most sensitive, but also the least specific, symptom.
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Affiliation(s)
- Laura Maffeis
- Pediatric Highly Intensive Care Unit, Fondazione IRCSS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Robertino Dilena
- Service of Pediatric Neurophysiology , Unit of Clinical Neurophysiology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Sophie Guez
- Pediatric Highly Intensive Care Unit, Fondazione IRCSS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesca Menni
- Pediatric Highly Intensive Care Unit, Fondazione IRCSS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Cristina Bana
- Service of Pediatric Neurophysiology , Unit of Clinical Neurophysiology, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Silvia Osnaghi
- Department of Ophthalmology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Carrabba
- Division of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Marchisio
- Pediatric Highly Intensive Care Unit, Fondazione IRCSS Ca’ Granda Ospedale Maggiore Policlinico, and a Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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White O, Yalamanchili S. IIH: Optic Nerve Sheath Fenestration Versus Shunt Placement. Neuroophthalmology 2019. [DOI: 10.1007/978-3-319-98455-1_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Roach ES. Eliminating the Secret Handshake: A Plea for Clarity in Medical Terminology. Pediatr Neurol 2018; 87:7-8. [PMID: 30501888 DOI: 10.1016/j.pediatrneurol.2018.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- E Steve Roach
- The University of Texas Dell Medical School, Austin, Texas.
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Gillson N, Jones C, Reem RE, Rogers DL, Zumberge N, Aylward SC. Incidence and Demographics of Pediatric Intracranial Hypertension. Pediatr Neurol 2017; 73:42-47. [PMID: 28668233 DOI: 10.1016/j.pediatrneurol.2017.04.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We analyzed the incidence and demographic features of pediatric intracranial hypertension. METHODS Inpatient and outpatient encounters of children aged 18 years or younger who were diagnosed with primary (idiopathic) or secondary intracranial hypertension between January 2010 and December 2013 were identified. Data were collected from a subspecialty clinic devoted to intracranial hypertension and the sole children's hospital in a large Midwestern city of the United States. Estimated incidence rates were calculated based on the number of newly diagnosed patients in our hospital's primary service area, which includes seven central Ohio counties. Sex, race, body mass index, socioeconomic status, and geographic distribution were also noted. RESULTS A total of 74 pediatric patients were diagnosed with intracranial hypertension (49 primary/idiopathic and 25 secondary) between January 2010 and December 2013. Using census data, we determined the pediatric population in our service area during the four-year period. The Ohio Hospital Association's database indicated that 92.3% of patients aged 0 to 17 years residing in the region sought care at our institution. By combining these data, we calculated an annual incidence of primary and secondary intracranial hypertension of 0.63 and 0.32 per 100,000 children, respectively. CONCLUSIONS The estimated annual incidence of pediatric primary intracranial hypertension in our seven county service area in central Ohio is similar to previous pediatric reports from other countries and is 67% of that reported in the US adult population.
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Affiliation(s)
- Natalie Gillson
- Division of Pediatric Neurology, Golisano Children's Hospital of Southwest Florida, Fort Myers, Florida
| | - Charlotte Jones
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | - Rachel E Reem
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio
| | - David L Rogers
- Department of Ophthalmology, Nationwide Children's Hospital, Columbus, Ohio
| | - Nicholas Zumberge
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Shawn C Aylward
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio.
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