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Seilanian Toosi F, Hashemi N, Emadzadeh M, Hassan Nejad E, Payandeh A, Tavakkolizadeh N, Akhondian J, Ashrafzadeh F, Beiraghi Toosi M, Shahmoradi Y, Pourzal M, Kazemi SA, Moodi Ghalibaf A, Beizaei B. The diagnostic value of MRI findings in pediatric idiopathic intracranial hypertension: a case-control study. Childs Nerv Syst 2024; 40:2115-2123. [PMID: 38478069 DOI: 10.1007/s00381-024-06354-3] [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: 02/10/2024] [Accepted: 03/01/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) is a rare medical condition in children. Based on the different radiological findings reported in various studies in pediatric IIH, this study was conducted to determine the diagnostic value of MRI findings in diagnosing IIH in children. METHODS In this retrospective study, the medical records of all children aged 1 to 18 years who visited Ghaem Hospital in Mashhad, Iran, between 2012 and 2022 and were diagnosed with IIH were gathered. Forty-nine cases of children with IIH and 48 control cases of children with the first unprovoked seizure with no indications of increased intracranial pressure for comparison were selected. Patient demographic information and MRI findings were extracted. The comparison between different MRI findings in the case and control groups was conducted using statistical tests. RESULTS In the case group, the mean diameter of the subarachnoid space expansion around the optic nerve was 5.96 ± 1.21, compared to 4.79 ± 0.33 in the control group, with statistically significant difference (P < 0.001). All the patients with flattening of the posterior globe or transverse sinus stenosis were in the case group, and the frequency of these findings in the case group was significantly higher than in the control group (P < 0.001). The majority of patients (95.5%) classified under category 3 and 4 of empty sella were part of the case group, and the statistical test results indicated a significant difference between the two groups (P < 0.001). The optic nerve sheath diameter cut-off of 5.35 mm, when used for expansion of the subarachnoid space around the optic nerve, with a sensitivity of 82% and a specificity of 100% in diagnosing IIH. CONCLUSION The most reliable diagnostic indicators for diagnosing IIH in children are perioptic subarachnoid space expansion with high sensitivity, and posterior globe flattening and transverse sinus stenosis with high specificity.
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Affiliation(s)
- Farrokh Seilanian Toosi
- Department of Radiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Narges Hashemi
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Emadzadeh
- Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Hassan Nejad
- Department of Radiology, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Asma Payandeh
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nahid Tavakkolizadeh
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Akhondian
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farah Ashrafzadeh
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehran Beiraghi Toosi
- Department of Pediatrics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Yousef Shahmoradi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - MohammadReza Pourzal
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Amirhossein Kazemi
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Behnam Beizaei
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Kalmar CL, Malphrus EL, Blum JD, Kosyk MS, Zapatero ZD, Heuer GG, Bartlett SP, Taylor JA, Lang SS, Swanson JW. Intracranial Pressure Patterns in Children with Sagittal Craniosynostosis. Plast Reconstr Surg 2024; 154:135e-145e. [PMID: 37285193 DOI: 10.1097/prs.0000000000010797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Elevated intracranial pressure (ICP) in sagittal craniosynostosis has a wide spectrum of reported incidence, and patterns are not well understood across infancy and childhood. Characterizing the natural history of ICP in this population may clarify risks for neurocognitive delay and inform treatment decisions. METHODS Infants and children with sagittal craniosynostosis and unaffected control subjects were prospectively evaluated with spectral-domain optical coherence tomography from 2014 to 2021. Elevated ICP was determined based on previously validated algorithms using retinal optical coherence tomography parameters. RESULTS Seventy-two patients with isolated sagittal craniosynostosis and 25 control subjects were evaluated. Overall, 31.9% ( n = 23) of patients with sagittal craniosynostosis had evidence of ICP greater than or equal to 15 mmHg, and 27.8% ( n = 20) of patients had ICP greater than or equal to 20 mmHg. Children with sagittal craniosynostosis younger than 6 months were more likely to have normal ICP (88.6% <15 mmHg; 91.4% <20 mmHg) than those aged between 6 and 12 months (54.5%, P = 0.013; 54.5%, P = 0.005) than those older than 12 months (46.2%, P < 0.001; 53.8%, P = 0.001). ICP was directly correlated with severity of scaphocephaly ( P = 0.009). No unaffected control subjects at any age exhibited retinal thickening suggestive of elevated ICP. CONCLUSION Elevated ICP is rare in isolated sagittal craniosynostosis younger than 6 months, but it becomes significantly more common after 6 months of age, and may correlate with severity of scaphocephaly. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, II.
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Affiliation(s)
| | | | - Jessica D Blum
- From the Divisions of Plastic and Reconstructive Surgery
| | | | | | | | | | - Jesse A Taylor
- From the Divisions of Plastic and Reconstructive Surgery
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Ng JJ, Saikali LM, Zapatero ZD, Massenburg BB, Wu M, Romeo DJ, Heuer GG, Bartlett SP, Taylor JA, Swanson JW, Lang SS. Vaulting further: cranial vault expansion for craniocerebral disproportion without primary craniosynostosis. Childs Nerv Syst 2024:10.1007/s00381-024-06517-2. [PMID: 38922367 DOI: 10.1007/s00381-024-06517-2] [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: 03/19/2024] [Accepted: 06/20/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE Treatment of subjects with refractory idiopathic intracranial hypertension (IIH) or shunted hydrocephalus with chronic shunt complications is challenging. What is the role for cranial vault expansion, particularly utilizing posterior vault distraction osteogenesis (PVDO), in these cases? This study assesses medium-term efficacy of cranial vault expansion in this unique patient population. METHODS A retrospective review was conducted of patients who underwent cranial vault expansion from 2008 to 2023 at the Children's Hospital of Philadelphia. Subjects who did not have a diagnosis of primary craniosynostosis were included in the study. Demographic information, medical history, and perioperative details were collected from medical records. Primary outcomes were the rate of CSF diversion procedures and resolution of presenting signs and symptoms. Secondary outcomes were perioperative and 90-day complications and reoperation requirement. RESULTS Among 13 included subjects, nine (69.2%) patients had a primary diagnosis of shunted hydrocephalus and 4 (30.8%) patients had IIH. Twelve (92.3%) subjects underwent posterior vault distraction osteogenesis (PVDO) and one (7.7%) underwent posterior vault remodeling (PVR). All 4 patients with IIH demonstrated symptomatic improvement following PVDO, including resolution of headaches, vomiting, and/or papilledema. Among 9 patients with shunted hydrocephalus, CSF diversion requirement decreased from 2.7 ± 1.6 procedures per year preoperatively to 1.2 ± 1.8 per year following cranial vault expansion (p = 0.030). The mean postoperative follow-up was 4.1 ± 2.1 years and four (30.8%) patients experienced complications within 90 days of surgery, including infection (n = 2), CSF leak (n = 1), and elevated ICP requiring lumbar puncture (n = 1). Four (30.8%) patients underwent repeat cranial vault expansion for recurrence of ICP-related symptoms. At most recent follow-up, 7 of 9 patients with shunted hydrocephalus demonstrated symptomatic improvement. CONCLUSION Cranial vault expansion reduced intracranial hypertension-related symptomology as well as the rate of CSF diversion-related procedures in patients with refractory IIH and shunted hydrocephalus without craniosynostosis, and should be considered in those who have significant shunt morbidity.
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Affiliation(s)
- Jinggang J Ng
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Linda M Saikali
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Zachary D Zapatero
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Plastic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Benjamin B Massenburg
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Meagan Wu
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dominic J Romeo
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gregory G Heuer
- Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Scott P Bartlett
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Plastic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jesse A Taylor
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Plastic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jordan W Swanson
- Division of Plastic, Reconstructive and Oral Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Plastic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Shih-Shan Lang
- Division of Neurosurgery, Children's Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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Şener N, Aldwib AEO. New Antibacterial 1,3,4-Thiadiazole Derivatives With Pyridine Moiety. Chem Biodivers 2024; 21:e202400522. [PMID: 38606431 DOI: 10.1002/cbdv.202400522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/13/2024]
Abstract
1,3,4-Thiadiazole compounds were synthesized using pyridine carboxylic acid derivatives and thiosemicarbazide derivatives. The molecular structures of the resulting compounds were characterized by spectroscopic methods such as ATR-FTIR, 1H-NMR, and elemental analysis. Its compounds were also examined for their antibacterial properties against some strains of bacteria. Five synthesized compounds showed varying antibacterial effects on Escherichia coli, Salmonella kentucky, Bacillus substilis and Klebsiella pneumoniae. This result revealed that some of the resulting compounds could be antibacterial agents.
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Affiliation(s)
- Nesrin Şener
- Department of Chemistry, Faculty of Science, Kastamonu University, 37200, Kastamonu, Turkey
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Espitia Segura OM, Bedoya Morales AM, Ramírez-Sierra CL, Farfán-Albarracín JD, Pérez Cárdenas SH, Sánchez Rincón JD, Guzmán-Porras JJ, López Mora LF, Ramírez Salazar MH, Ceballos Inga LA, Rueda Rodríguez MC, Téllez Prada HA, Castro Rubio JC, Lemus Espitia I, Guevara Ramos JD. Headache and Other Factors Modifying Cerebrospinal Fluid Opening Pressure in Pediatric Patients. J Child Neurol 2024; 39:195-200. [PMID: 38748539 DOI: 10.1177/08830738241252209] [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: 06/13/2024]
Abstract
Cerebrospinal fluid opening pressure values are associated with various neurologic diseases; however, numerous factors can modify this measurement. This study aims to describe factors related to modifications in opening pressure measurements in pediatric patients. Methods: A retrospective analysis of lumbar punctures in pediatric patients conducted by the neuropediatrics group with institutional standardization. Bivariate and linear regression analyses were performed to determine the association between opening pressure and variables included in the study. Results: 544 events, median age 107 months, median opening pressure 19.7 cm H2O. Bivariate analysis found no association with medication use; anesthetics that increased opening pressure were remifentanil (P = .02) and propofol (P = .05), along with a positive linear correlation between opening pressure and age (P < .0001). Multiple linear regression analysis revealed that age, BMI, male gender, and remifentanil use were associated with an increase in opening pressure, whereas corticosteroid withdrawal was associated with a reduction in opening pressure. There is an interaction between age and headache, with an association with increased opening pressure up to around 140 months. Conclusion: This study identifies factors associated with changes in opening pressure, crucial for estimating normal opening pressure values in children. Headaches, anesthetic use, and corticosteroid withdrawal are confirmed as significant factors.
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Affiliation(s)
- Oscar M Espitia Segura
- Qualitative and Quantitative Research Network in Child Neurology (RICCNeP), Bogotá, Colombia
- Child Neurology Division, HOMI Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
| | - Ana M Bedoya Morales
- Qualitative and Quantitative Research Network in Child Neurology (RICCNeP), Bogotá, Colombia
- Child Neurology Division, HOMI Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
- Child Neurology Division, Clínica Infantil Santa María del Lago, Bogotá, Colombia
| | - Cristina L Ramírez-Sierra
- Qualitative and Quantitative Research Network in Child Neurology (RICCNeP), Bogotá, Colombia
- Child Neurology Division, Clínica Infantil Santa María del Lago, Bogotá, Colombia
- School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Juan D Farfán-Albarracín
- Qualitative and Quantitative Research Network in Child Neurology (RICCNeP), Bogotá, Colombia
- Child Neurology Division, HOMI Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
- School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Sofy H Pérez Cárdenas
- Qualitative and Quantitative Research Network in Child Neurology (RICCNeP), Bogotá, Colombia
- Child Neurology Division, HOMI Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
| | - Juan D Sánchez Rincón
- Qualitative and Quantitative Research Network in Child Neurology (RICCNeP), Bogotá, Colombia
- Child Neurology Division, HOMI Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
- School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Jennifer J Guzmán-Porras
- Qualitative and Quantitative Research Network in Child Neurology (RICCNeP), Bogotá, Colombia
- Child Neurology Division, HOMI Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
- School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Luisa F López Mora
- Qualitative and Quantitative Research Network in Child Neurology (RICCNeP), Bogotá, Colombia
- Child Neurology Division, HOMI Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
- School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Mateo H Ramírez Salazar
- Qualitative and Quantitative Research Network in Child Neurology (RICCNeP), Bogotá, Colombia
- Child Neurology Division, HOMI Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
- School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Leydi A Ceballos Inga
- Qualitative and Quantitative Research Network in Child Neurology (RICCNeP), Bogotá, Colombia
- Child Neurology Division, HOMI Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
- School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia
| | - María C Rueda Rodríguez
- Qualitative and Quantitative Research Network in Child Neurology (RICCNeP), Bogotá, Colombia
- Child Neurology Division, HOMI Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
| | - Hugo A Téllez Prada
- Qualitative and Quantitative Research Network in Child Neurology (RICCNeP), Bogotá, Colombia
- Child Neurology Division, HOMI Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
| | - Juan C Castro Rubio
- Qualitative and Quantitative Research Network in Child Neurology (RICCNeP), Bogotá, Colombia
| | - Ingrid Lemus Espitia
- Qualitative and Quantitative Research Network in Child Neurology (RICCNeP), Bogotá, Colombia
- Child Neurology Division, HOMI Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
| | - Juan D Guevara Ramos
- Qualitative and Quantitative Research Network in Child Neurology (RICCNeP), Bogotá, Colombia
- Child Neurology Division, HOMI Fundación Hospital Pediátrico La Misericordia, Bogotá, Colombia
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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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Çıvgın E, Duran S, Parlak IS, Gülleroğlu B, Timur İEE, Dedeoğlu Ö, Ekşioğlu ASY. New-Onset Vision Impairment in Children: Magnetic Resonance Imaging Findings by Age Groups. J Child Neurol 2024; 39:122-128. [PMID: 38504646 DOI: 10.1177/08830738241239696] [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: 03/21/2024]
Abstract
INTRODUCTION Non-traumatic visual impairment is rare in the pediatric population, but early diagnosis and treatment of the cause is crucial to prevent long-term consequences affecting children's neurocognitive development. The authors aim to determine the most common causes of non-traumatic visual impairment in pediatric patients according to age groups by magnetic resonance imaging (MRI). METHODS Images of patients who underwent contrast-enhanced cranial and orbital MRI for new-onset visual impairment between June 2019 and June 2022 were retrospectively reviewed. MRI findings were categorized as tumors, idiopathic intracranial hypertension, demyelinating disorders, infections, isolated optic neuritis, and others. The patients were grouped according to age as preschoolers, schoolchildren, and adolescents. Demographic features of patients and MRI findings were collected and compared among age groups. RESULTS One hundred seventeen of the 238 patients had pathologic MRI findings. The most common pathologies were tumors (26.4%), idiopathic intracranial hypertension (24.7%), demyelinating disorders (18.8%), infections (11.1%), and isolated optic neuritis (7.6%). Tumors (69.2%) in preschool children, idiopathic intracranial hypertension (36.3%) in schoolchildren, and demyelinating disorders (32.7%) in adolescents were the most common cause of vision impairment by age group. CONCLUSION Children with acute vision impairment could have severe pathologies. Tumors in preschool children, idiopathic intracranial hypertension in schoolchildren, and demyelinating disorders in adolescents were the most common causes of new-onset vision impairment detected with MRI. Because of the difficulty of performing optimal ophthalmologic and neurologic examinations, especially in young children, cranial and orbital MRI should be considered to detect life-threatening pathologies.
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Affiliation(s)
- Esra Çıvgın
- Department of Radiology, Ankara Bilkent City Hospital, Ankara, Türkiye
| | - Semra Duran
- Department of Radiology, Ankara Bilkent City Hospital, Ankara, Türkiye
| | | | - Başak Gülleroğlu
- Department of Pediatric Radiology, Ankara Bilkent City Hospital, Ankara, Türkiye
| | | | - Özge Dedeoğlu
- Department of Pediatric Neurology, Ankara Bilkent City Hospital, Ankara, Türkiye
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Lee R, Mortensen P, Raviskanthan S, Sadrameli S, Al-Zubidi N, Lee AG. Delayed Symptomatic Lumboperitoneal Shunt Malfunction 18 Years After Stability. J Neuroophthalmol 2023; 43:e169-e170. [PMID: 35427286 DOI: 10.1097/wno.0000000000001585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ryung Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital (RL, PM, SR, NA-Z, AGL), Houston, Texas; and Department of Head and Neck Surgery (NA-Z), Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas; Department of Neurosurgery (SS), Houston Methodist Hospital, Houston Texas; Ophthalmology, Neurology, and Neurosurgery (AGL), Weill Cornell Medicine, New York, New York; and Department of Ophthalmology (AGL, NA-Z), Baylor College of Medicine, University of Iowa Hospitals and Clinics, University of Buffalo (SUNY) UTMB, Galveston and the UT MD Anderson Cancer Center, Houston, Texas
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9
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Rosenbaum ARP, Jewell JL, Searns JB. Infant with Acute Onset Esotropia. Pediatr Rev 2023; 44:S55-S58. [PMID: 37777233 DOI: 10.1542/pir.2021-005330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
| | - Jerry L Jewell
- Department of Pediatrics
- Department of Neurology, University of Colorado, Aurora, CO
| | - Justin B Searns
- Department of Pediatrics
- Division of Hospital Medicine; Division of Infectious Diseases, Department of Pediatrics, University of Colorado, Aurora, CO
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10
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Asal N, Bayar Muluk N, Özdemir A, Say B. Evaluation of peripheral and central olfactory regions by MRI in patients with idiopathic intracranial hypertension. Neurol Res 2023; 45:346-353. [PMID: 36373831 DOI: 10.1080/01616412.2022.2146261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We investigated the peripheral and central smell regions in patients with idiopathic intracranial hypertension (IIH) by cranial MRI. METHODS In this retrospective study, cranial MRI images of 43 adult patients with IIH (Group 1) and 43 healthy adults without IIH (Group 2) were included. In both groups, peripheral [Olfactory bulb (OB) volume and Olfactory sulcus (OS) depth] and central smell regions (insular gyrus and corpus amygdala area, and thalamus volume) were measured in cranial MRI. RESULTS Bilateral OB volume and insular gyrus area, and right corpus amygdala and thalamus volumes of the IIH group were significantly lower than those of the control group (p < 0.05). In the IIH group, OB volume of the right side was significantly lower, and insular gyrus area of the right side was significantly higher than those of the left side (p < 0.05). In the IIH group, there were positive correlations between OB volumes; OS depths; insular gyrus areas; corpus amygdala areas; and thalamus volumes bilaterally (p < 0.05). In older patients, right OS depth and right corpus amygdala area decreased (p < 0.05). CONCLUSION In conclusion, IIH may be related to olfactory impairment. Cranial MRI images showed a decrease in peripheral (OB volume) and central (insular gyrus and corpus amygdala area and thalamus volume) smell regions. To prevent olfactory impairment in IIH patients, treatment should be done in IIH patients to decrease intracranial pressure. It is very important to prevent the circulation of CSF with increased pressure between the sheets of the olfactory nerve in IIH patients.
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Affiliation(s)
- Neşe Asal
- Faculty of Medicine, Radiology Department, Kırıkkale University, Kırıkkale, Turkey
| | - Nuray Bayar Muluk
- Faculty of Medicine, ENT Department, Kırıkkale University, Kırıkkale, Turkey
| | - Adnan Özdemir
- Faculty of Medicine, Radiology Department, Kırıkkale University, Kırıkkale, Turkey
| | - Bahar Say
- Faculty of Medicine, Neurology Department, Kırıkkale University, Kırıkkale, Turkey
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11
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Sheldon CA, Reggie SN, Paley GL, McCormack SE, Liu GT. Effects of acetazolamide on linear growth in children with pseudotumor cerebri syndrome. FRONTIERS IN OPHTHALMOLOGY 2023; 2:1042529. [PMID: 38983548 PMCID: PMC11182249 DOI: 10.3389/fopht.2022.1042529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/28/2022] [Indexed: 07/11/2024]
Abstract
Background/introduction While oral acetazolamide is a cornerstone of management of adult and pediatric PTCS, previous studies have suggested that acetazolamide used in children with other conditions may influence growth. Aims and methods Retrospective chart review involving a single tertiary medical center. Thirty-four children with definite or probable PTCS were identified. Analysis was restricted to individuals from whom anthropometric data were available before and during acetazolamide treatment (n=22). Results Half of individuals (n=11/22) showed a decline in BMI Z-scores. Sixty-three percent (n=14/22) showed a decrease in height Z-scores during treatment with acetazolamide; in 6 of these 14 children who had complete data, 3 showed at least a partial recovery of height Z-scores after discontinuation of acetazolamide. Conclusion Acetazolamide may be associated with growth suppression in some children treated for pediatric PTCS. In some cases, the growth suppression appears to reverse once the acetazolamide is stopped.
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Affiliation(s)
- Claire A. Sheldon
- Department of Ophthalmology, University of British Columbia, Vancouver, BC, Canada
| | - Sara N. Reggie
- Ophthalmic Plastic & Cosmetic Surgery, Inc., St. Louis, MO, United States
| | - Grace L. Paley
- Department of Ophthalmology, Washington University, St. Louis, MO, United States
| | - Shana E. McCormack
- Division of Endocrinology and Diabetes, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Grant T. Liu
- Neuro-ophthalmology Service, Division of Ophthalmology, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
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van de Beeten SDC, Kurniawan MSIC, Kamst NW, Loudon SE, Mathijssen IMJ, van Veelen MLC. Early and long-term skull growth after surgical correction for sagittal synostosis in relation to the occurrence of papilledema. Childs Nerv Syst 2023; 39:211-220. [PMID: 36053310 PMCID: PMC9968680 DOI: 10.1007/s00381-022-05629-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 07/19/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Stagnation of skull growth is correlated with papilledema in craniosynostosis. In this retrospective cohort study, we describe the postoperative skull growth after surgical correction for sagittal synostosis and its relation to the development of papilledema. METHODS Patients with isolated sagittal synostosis at our center between 2005 and 2012 were included. Occipitofrontal circumference (OFC) was analyzed, at 3 time points (preoperative, 2 years postoperative, and last OFC measurement) and 3 phases (initial postoperative growth, long-term growth, and overall growth), and related to papilledema on fundoscopy. RESULTS In total, 163 patients were included. The first time interval showed a decline in skull growth, with subsequent stabilization at long term. Papilledema occurred postoperatively in 10 patients. In these patients, the OFC at 2 years and at last follow-up (T3) were significantly smaller than in patients without papilledema. A larger OFC resulted in a decreased odds of developing papilledema at both postoperative time points (at T2 (OR = 0.40, p = 0.01) and at T3 (OR 0.29, p < 0.001)). Sensitivity and specificity analysis indicated that an OFC below 0.25 SD at T2 (sensitivity 90%, specificity 65%) and below 0.49 at T3 (sensitivity 100%, specificity 60%) are related to the occurrence of papilledema. CONCLUSION A small OFC is correlated with the occurrence of papilledema. A decline in OFC within 2 years postoperatively is common in sagittal synostosis and is acceptable up to a value of 0.25SD. Patients with an OFC at last follow-up of less than 0.5SD are at risk for developing papilledema.
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Affiliation(s)
- Stephanie D C van de Beeten
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus Medical Center, Room Ee15.91, 2040, 3000 CA, Rotterdam, the Netherlands
| | - Melissa S I C Kurniawan
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus Medical Center, Room Ee15.91, 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Nathalie W Kamst
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus Medical Center, Room Ee15.91, 2040, 3000 CA, Rotterdam, the Netherlands
| | - Sjoukje E Loudon
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Irene M J Mathijssen
- Department of Plastic and Reconstructive Surgery and Hand Surgery, Erasmus Medical Center, Room Ee15.91, 2040, 3000 CA, Rotterdam, the Netherlands
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13
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Alqahtani YAM, Aljabri MF, Oshi MAM, Kamal NM, Elhaj W, Abosabie SA, Abosabie SA. An Unusual Case of Headache in a Child: Idiopathic Intracranial Hypertension with Diagnostic Challenge. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2023; 16:11795476231158509. [PMID: 36874375 PMCID: PMC9974625 DOI: 10.1177/11795476231158509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/02/2023] [Indexed: 03/06/2023]
Abstract
Introduction In children, idiopathic intracranial hypertension (IIH) is relatively uncommon. It is characterized by an increase in intracranial pressure, in the absence of evidence of underlying brain disease, structural abnormalities, hydrocephalus, or abnormal meningeal improvement. However, very rarely it can occur without papilledema, even though it is the most recognizable clinical sign. Due to this, a delay in diagnosis can lead to severe visual impairments. Case presentation We describe a patient with a chronic headache but no papilledema. His neurological and systemic examinations were otherwise unremarkable. A lumbar puncture revealed a high opening pressure of 450 mmH2O and normal cerebrospinal fluid (CSF) parameters. Magnetic resonance imaging of the brain revealed only tortuous optic nerves, no parenchymal lesions, and no evidence of venous sinus thrombosis. He required acetazolamide treatment. Our patient's symptoms improved significantly in 2 months with medical treatment, weight loss, and exercise, with no development of papilledema. Conclusion There is a wide range of clinical manifestations of IIH, making it difficult to decide when to begin treatment.
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Affiliation(s)
- Youssef Ali M Alqahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mohammed Fahad Aljabri
- Neurology Division, Department of Pediatrics, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | | | - Naglaa M Kamal
- Kasr Alainy Faculty of Medicine, Cairo University, Egypt
| | - Waleed Elhaj
- Neurology Division, Department of Pediatrics, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Sara A Abosabie
- Faculty of Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Salma As Abosabie
- Faculty of Medicine, Julius-Maximilians-Universität Würzburg, Bavaria, Germany
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14
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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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15
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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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16
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Masri A, Al Jaberi M, Shihadat R, Rayyan A, AlMasri M, Abuna'meh L, Ali M, Al Ryalat N, Hadidy A, Al-Shakkah AA. Pseudotumor cerebri syndrome in children: Clinical characteristic and re-classification. Brain Dev 2022; 44:446-453. [PMID: 35393129 DOI: 10.1016/j.braindev.2022.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 11/28/2022]
Abstract
AIM To describe the clinical characteristics of children with pseudotumor cerebri syndrome (PTCS) who were diagnosed according to the modified Dandy criteria and to reclassify them according to the newly proposed diagnostic criteria by Freidman. METHODOLOGY This retrospective study included the period from January 2016-to July 2021. RESULTS 50 patients were included; 34 males and 16 females with a male to female ratio of 2.1:1. The average age at onset of symptoms was 8 years. Obesity was noticed in 6 (12%) patients; 34 (68%) had symptoms upon presentation. The most common presenting symptom was headache (28 patients; 56%), papilledema was present in 33 (66%) patients. Most patients (37; 74%) had an initial cerebrospinal fluid (CSF) pressure ≥280 mmH2O. At last follow-up, papilledema resolved in 11/32 (34.3%) patients, and headache resolved in 17/23 (74%) patients. 22/50 (44%) patients fulfilled the definite criteria proposed by Freidman, 11/50 (22%) fulfilled the probable, 10/50 (20%) were categorized as possible, and 7 (14%) patients were categorized as unmet. CONCLUSION PTCS is a chronic condition. Managing patients who do not have papilledema or who do not meet the newly proposed higher CSF pressure is challenging. Although, applying the newly proposed criteria captured most of our patients, however, around one quarter were managed based on clinical experience. This study indicates a strong need for future guidelines tailored specifically for children, taking into consideration that the cut-off point of CSF pressure might not be similar for all populations.
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Affiliation(s)
- Amira Masri
- Department of Paediatrics,division of child neurology , Faculty of Medicine, The University of Jordan.
| | | | | | | | | | - Lina Abuna'meh
- Department of Paediatrics,division of child neurology , Faculty of Medicine, The University of Jordan
| | - Majd Ali
- Department of Paediatrics,division of child neurology , Faculty of Medicine, The University of Jordan
| | - Nosaiba Al Ryalat
- Department of Radiology, Faculty of Medicine, The University of Jordan
| | - Azmy Hadidy
- Department of Radiology, Faculty of Medicine, The University of Jordan
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Zafar S, Panthangi V, Cyril Kurupp AR, Raju A, Luthra G, Shahbaz M, Almatooq H, Foucambert P, Esbrand FD, Khan S. A Systematic Review on Whether an Association Exists Between Adolescent Obesity and Idiopathic Intracranial Hypertension. Cureus 2022; 14:e28071. [PMID: 36127965 PMCID: PMC9477550 DOI: 10.7759/cureus.28071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/16/2022] [Indexed: 11/19/2022] Open
Abstract
Pseudotumor cerebri syndrome (PTCS)/idiopathic intracranial hypertension (IIH) is a clinical presentation appertaining to signs/symptoms of raised intracranial pressure, like headache and papilledema. It is an uncommon but clinically significant cause of morbidity such as permanent vision loss. It is crucial to understand if idiopathic intracranial hypertension (IIH) is on the rise in adolescents, it is probably due to the rising prevalence of obesity worldwide. Our study aimed to find an association between obesity and IIH in adolescents. We utilized Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 (PRISMA) guidelines to run this systematic review. Many publications related to the topic in the discussion were scrutinized through a comprehensive database search. We filtered them down to a final count of 10 articles after utilizing our inclusion/exclusion criteria and assessing the quality of work. In these final papers, we identified several possibilities to explain the link between obesity and IIH in adolescents. Overweight and obese adolescents were found to have a significantly increased risk of IIH development, with a more severe clinical picture seen in morbidly obese female patients.
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Affiliation(s)
- Sana Zafar
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Venkatesh Panthangi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Anjumol Raju
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Gaurav Luthra
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Mahrukh Shahbaz
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Halah Almatooq
- Dermatology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Paul Foucambert
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Faith D Esbrand
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Safeera Khan
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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18
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Myopia and Other Visual Disorders in Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158912. [PMID: 35897282 PMCID: PMC9332575 DOI: 10.3390/ijerph19158912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 12/10/2022]
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19
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Landau Prat D, Liu GT, Avery RA, Ying GS, Chen Y, Tomlinson LA, Revere KE, Katowitz JA, Katowitz WR. Recovery of Vision after Optic Nerve Sheath Fenestration in Children and Adolescents with Elevated Intracranial Pressure. Am J Ophthalmol 2022; 237:173-182. [PMID: 34848170 DOI: 10.1016/j.ajo.2021.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the effect of optic nerve sheath fenestration (ONSF) on the recovery of visual function in pediatric patients with optic disc swelling owing to increased intracranial pressure. DESIGN Retrospective case series. METHODS Medical chart review of all pediatric patients who underwent ONSF between 2009 and 2020 at the Children's Hospital of Philadelphia. Visual function was assessed at pre and postoperative visits. The main outcome measures were visual acuity, color vision, extraocular motility, visual field mean deviation, retinal nerve fiber layer thickness measured by optical coherence tomography. RESULTS Fourteen pediatric patients (10 females; mean ± SD age of 14 ± 2.6 years; range, 8.5-17.5 years) were included. Five patients underwent bilateral surgeries. Ten patients were diagnosed with idiopathic intracranial hypertension. Of the 10 idiopathic intracranial hypertension patients, 3 had a previous history of weight gain and 2 of systemic steroid treatment; these can be referred to as pseudotumor cerebri. The mean ± SD follow-up length was 16.4 ± 12.3 months. VA improved from 20/138 to 20/68 in the operated eye (P = .0003) and from 20/78 to 20/32 in the nonoperated eye (P = .02). Color vision improved in the operated eye (P = .04), extraocular motility improved in the operated and nonoperated eye (P = .002 and P = .04 respectively). Visual field mean deviation improved in the operated (-23.4 dB to -11.5 dB, P < .0001) and nonoperated eye (-19.8 dB to -6.8 dB, P = .02). Retinal nerve fiber layer thickness improved in the operated eye (349.1 to 66.2 µm; P < .0001). The postoperative improvement was observed as early as the postoperative day 1. CONCLUSIONS ONSF produces a rapid and persistent vision improvement in both the operated eye and the nonoperated eye. In children and young adults with papilledema and elevated intracranial pressure causing vision loss that is severe at presentation or refractory to standard medical management, ONSF should be considered.
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Affiliation(s)
- Daphna Landau Prat
- Division of Ophthalmology, Children's Hospital of Philadelphia (D.L.P., G.T.L., R.A.A., L.A.T., K.A.R., J.A.K., W.R.K.), Philadelphia, Pennsylvania; Goldschleger Eye Institute, Division of Ophthalmology (D.L.P.), Talpiot Medical Leadership Program (D.L.P.), Sheba Medical Center, Israel; Sackler Faculty of Medicine (D.L.P.), Tel Aviv University, Tel Aviv, Israel.
| | - Grant T Liu
- Division of Ophthalmology, Children's Hospital of Philadelphia (D.L.P., G.T.L., R.A.A., L.A.T., K.A.R., J.A.K., W.R.K.), Philadelphia, Pennsylvania
| | - Robert A Avery
- Division of Ophthalmology, Children's Hospital of Philadelphia (D.L.P., G.T.L., R.A.A., L.A.T., K.A.R., J.A.K., W.R.K.), Philadelphia, Pennsylvania
| | - Gui-Shuang Ying
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology (G.-S.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yineng Chen
- Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology (G.-S.Y.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren A Tomlinson
- Division of Ophthalmology, Children's Hospital of Philadelphia (D.L.P., G.T.L., R.A.A., L.A.T., K.A.R., J.A.K., W.R.K.), Philadelphia, Pennsylvania
| | - Karen E Revere
- Division of Ophthalmology, Children's Hospital of Philadelphia (D.L.P., G.T.L., R.A.A., L.A.T., K.A.R., J.A.K., W.R.K.), Philadelphia, Pennsylvania
| | - James A Katowitz
- Division of Ophthalmology, Children's Hospital of Philadelphia (D.L.P., G.T.L., R.A.A., L.A.T., K.A.R., J.A.K., W.R.K.), Philadelphia, Pennsylvania
| | - William R Katowitz
- Division of Ophthalmology, Children's Hospital of Philadelphia (D.L.P., G.T.L., R.A.A., L.A.T., K.A.R., J.A.K., W.R.K.), Philadelphia, Pennsylvania
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20
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Gordillo BF, Benítez MP, León MM, Iglesias S. Lumboperitoneal shunting in pediatric patients and the role of imaging in its evaluation. RADIOLOGIA 2022; 64:136-144. [DOI: 10.1016/j.rxeng.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/01/2022] [Indexed: 11/26/2022]
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21
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Chang MY, Yim CK, Borchert MS. Increase in Pediatric Pseudotumor Cerebri Syndrome Emergency Department Visits, Inpatient Admissions, and Surgeries During the COVID-19 Pandemic. J Neuroophthalmol 2022; 42:e87-e92. [PMID: 34803141 PMCID: PMC9842394 DOI: 10.1097/wno.0000000000001480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Pediatric pseudotumor cerebri syndrome (PTCS) is a vision-threatening condition that is associated with female sex and obesity in pubertal and postpubertal children. It is unknown whether the increase in childhood obesity during the COVID-19 pandemic has affected the rates and characteristics of pediatric PTCS. METHODS We conducted a retrospective study of children evaluated for PTCS (inpatient or emergency department) at our children's hospital before (March 19, 2015 to March 19, 2020) and during (March 20, 2020 to February 20, 2021) the pandemic. We compared the monthly number of inpatient and emergency department encounters for pediatric PTCS before and during the pandemic. In addition, anthropometric and ophthalmologic characteristics of children evaluated for pediatric PTCS before and during the pandemic were compared. RESULTS A total of 36 encounters in the 5 years before the pandemic and 26 encounters in the 11 months during the pandemic were identified. The median monthly number of encounters for pediatric PTCS was significantly higher during the pandemic compared with the 5 years before the pandemic (2 vs 0, P = 0.0021). Compared with prepandemic patients, children evaluated during the pandemic were older (median age 16 vs 14 years, P = 0.02), with higher rates of obesity (85% vs 66%, P = 0.05) and lower likelihood of reporting Caucasian race (4% vs 31%, P = 0.02). Pandemic patients had worse presenting visual acuity (median logMAR 0.14 vs 0.05, P = 0.05) and were more likely to have fulminant presentation (23% vs 6%, P = 0.04) and require surgical intervention (23% vs 6%, P = 0.04). CONCLUSIONS At our children's hospital, the rate of inpatient admissions and emergency department visits for pediatric PTCS increased during the pandemic. The severity of disease and frequency of surgical treatment also increased. Racial and ethnic minorities seem to be disproportionately affected. These changes may be related to increasing rates of childhood obesity during the pandemic.
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Affiliation(s)
- Melinda Y Chang
- Department of Ophthalmology, Roski Eye Institute, University of Southern California (MYC, CY, MSB), Los Angeles, California; and Vision Center at Children's Hospital Los Angeles (MYC, CY, MSB), Los Angeles, California
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22
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Fernández Gordillo B, Pérez Benítez M, Martínez León M, Iglesias S. La derivación lumbo-peritoneal en la edad pediátrica y el papel de la imagen en su valoración. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.02.001] [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]
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Elevated Intracranial Pressure in Patients with Craniosynostosis by Optical Coherence Tomography. Plast Reconstr Surg 2022; 149:677-690. [PMID: 35041630 DOI: 10.1097/prs.0000000000008821] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Craniosynostosis may lead to elevated intracranial pressure, which may be implicated with impaired neurocognitive development. However, accurately measuring intracranial pressure is challenging, and patterns in craniosynostosis patients are poorly characterized. Spectral-domain optical coherence tomography may enable noninvasive assessment of intracranial pressure in pediatric patients with craniosynostosis. METHODS Pediatric patients with craniosynostosis undergoing surgical intervention between 2014 and 2019 prospectively underwent optical coherence tomographic evaluation. Intracranial pressure was directly measured intraoperatively in a subset of cases. Optical coherence tomographic parameters were compared to directly measured intracranial pressure and used for pattern assessment. RESULTS Optical coherence tomography was performed in 158 subjects, among which 42 underwent direct intracranial pressure measurement during an initial cranial procedure. Maximal retinal nerve fiber layer thickness, maximal retinal thickness, and maximal anterior projection optical coherence tomographic parameters were positively correlated with intracranial pressure (p ≤ 0.001), with all parameters showing significantly higher values in patients with intracranial pressure thresholds of 15 mmHg (p < 0.001) and 20 mmHg (p ≤ 0.007). Patients with maximal retinal nerve fiber layer thickness and maximal anterior projection exceeding set thresholds in optical coherence tomography of either eye demonstrated 77.3 percent sensitivity and 95.0 percent specificity for detecting intracranial pressure above 15 mmHg, and 90.0 percent sensitivity and 81.3 percent specificity for detecting intracranial pressure above 20 mmHg. Patients with associated syndromes or multiple suture involvement and patients aged 9 months or older were significantly more likely to have elevated intracranial pressure above 15 mmHg (p ≤ 0.030) and above 20 mmHg (p ≤ 0.035). CONCLUSIONS Spectral-domain optical coherence tomography can noninvasively detect elevated intracranial pressure in patients with craniosynostosis with reliable sensitivity and specificity. This technology may help guide decisions about the appropriate type and timing of surgical treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, I.
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Mohamed Teleb MA, Kamel MG, Ead HA, Hassaneen HM, Saleh FM. Reactivity of N-(4-Nitrophenyl)propionohydrazonoyl Bromide. Synthesis and Antimicrobial Study of Thiadiazoles and 4,6-Dithia-1,2,9-triazaspiro-[4.4]-non-2-en-8-ones. Polycycl Aromat Compd 2021. [DOI: 10.1080/10406638.2021.2019065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | - Monica G. Kamel
- Department of Chemistry, Faculty of Science, Cairo University, Giza, Egypt
| | - Hamed A. Ead
- Department of Chemistry, Faculty of Science, Cairo University, Giza, Egypt
| | - Hamdi M. Hassaneen
- Department of Chemistry, Faculty of Science, Cairo University, Giza, Egypt
| | - Fatma M. Saleh
- Department of Chemistry, Faculty of Science, Cairo University, Giza, Egypt
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25
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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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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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Hoyos-Martinez A, Horne VE, Wood AC, Shah V. Prevalence of Adrenal Insufficiency and Glucocorticoid Use in Pediatric Pseudotumor Cerebri Syndrome. J Neuroophthalmol 2021; 41:e451-e457. [PMID: 33110007 DOI: 10.1097/wno.0000000000001111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The pathophysiology underlying pseudotumor cerebri syndrome (PTCS) is complex and not well understood. There are clear differences between PTCS in adults and pediatrics. Few and isolated case reports have suggested that adrenal function may be involved, yet no large cohort study has examined this relationship. METHODS We conducted a retrospective single-center study of children who presented with a diagnosis of PTCS and had cortisol testing measured between January 2010 and September 2019. We included all subjects meeting the revised PTCS diagnostic criteria after the chart review. Based on morning, random or 1-μg cosyntropin stimulated cortisol levels, adrenal functioning was classified as: (1) insufficient (peak cortisol <16 μg/dL and AM cortisol <5 μg/dL), (2) at risk (peak cortisol 16-20 μg/dL, AM cortisol 5-13 μg/dL, or random <13 μg/dL), or (3) sufficient (peak cortisol >20 μg/dL and AM or random cortisol >13 μg/dL). RESULTS A total of 398 individuals were reviewed, and 64 were included for analysis. Of these, 40.6% were men, of mixed race and ethnicity with a mean age of 10.5 (SD 4.7) years. Of these, 23% and 52% had insufficient or at-risk cortisol levels. The majority of those in the insufficient (70%) or at-risk (80%) groups were exposed to topical, nasal, or inhaled glucocorticoids but not systemic. Only 60% and 12% of those with PTCS with insufficient or at-risk cortisol testing, respectively, underwent definitive testing with a stimulation test. CONCLUSIONS Glucocorticoid use and hypocortisolism are prevalent in PTCS and need consideration as a potential underlying cause. Most children had insufficient or at-risk cortisol levels, and many did not undergo further testing/workup. Children who present with PTCS, particularly young, males should be evaluated for adrenal insufficiency and its risk factors, including nonsystemic steroids. Prospective studies are necessary to further evaluate the effect of cortisol in relation to pediatric PTCS.
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Affiliation(s)
- Alfonso Hoyos-Martinez
- Department of Pediatrics, Section of Pediatric Diabetes and Endocrinology (AH-M, VEH), Baylor College of Medicine | Texas Children's Hospital, Houston, Texas; USDA/ARS Children's Nutrition Research Center (ACW), Houston, Texas; Department of Ophthalmology (VS), Baylor College of Medicine, Houston, Texas; Cincinnati Children's Hospital Medical Center (VS), Abrahamson Pediatric Eye Institute/Division of Pediatric Ophthalmology, Cincinnati, Ohio; and Department of Ophthalmology (VS), University of Cincinnati, Cincinnati, Ohio
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Clinical features and the role of magnetic resonance imaging in pediatric patients with intracranial hypertension. Acta Neurol Belg 2021; 121:1567-1573. [PMID: 32666506 DOI: 10.1007/s13760-020-01415-1] [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: 03/03/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
Increased intracranial hypertension (IIH) is a defined clinical condition; however, an unsolved pathophysiologic background usually creates problems in its diagnosis and proper approach. The aim of this study was to emphasize the clinical conditions and brain magnetic resonce imaging (MRI) clues of pediatric patients, especially this clinical entity with high morbidity. Here, we review the etiology, clinical presentation, brain MRI findings, and prognosis of IIH in children. The symptoms' onset age ranged from 9 months to 16 years. Headache (81%), vomiting (37%), and diplopia (33.3%) were the most frequent symptoms. The most common etiologic factors were found to be obesity and dural venous sinus thrombosis. Cerebrospinal fluid (CSF) opening pressure had mean a mean value of 615.2 ± 248 mm H2O. A significant relationship was found between visual field impairment and height of CSF pressure (p < 0.001). Optic nerve sheath enlargement (88.8%) and optic nerve tortuosity (85.1%) were found as the most common brain MRI findings. Slit-like ventricle (37%), venous sinus thrombosis (29.6%), posterior globe sclera flattening (29.6%), empty sella (25.9%), and intraocular protrusion of the optic nerve (14.8%) were the other findings. A significant relationship was found between CSF opening pressure and the presence of optic nerve tortuosity (p = 0.002), and distension of the optic nerve sheath (p = 0.006). All patients received acetazolamide, only one patient underwent lumboperitoneal shunt, and only one received steroids. In children, IIH can present with different etiologies and symptoms. Brain MRI provides crucial clues in diagnosis. Urgent diagnosis and treatment planning are required to protect vision functions.
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A case with kidney transplant and cystinosis: Answers. Pediatr Nephrol 2021; 36:2145-2147. [PMID: 33730271 DOI: 10.1007/s00467-021-05008-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 10/21/2022]
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Ahn S, Lee JM, Kim YM, Jeon H, Choi CH. Idiopathic Intracranial Hypertension following Ventriculoperitoneal Shunt Malfunction in Infant Hydrocephalus. KOSIN MEDICAL JOURNAL 2021. [DOI: 10.7180/kmj.2021.36.1.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
<p>Idiopathic intracranial hypertension (IIH) is a syndrome defined by elevated intracranial pressure without any abnormal findings. In the present study, we report a rare case of IIH in a patient after ventriculoperitoneal shunt (VPS) due to infant hydrocephalus. A 13-year-old girl with a history of VPS due to infant hydrocephalus was admitted to emergency room with the complaint of severe headache and visual disturbance. Brain computed tomography showed normal findings. However, based on the measurement by lumbar puncture, her cerebrospinal fluid (CSF) pressure was observed to be very high. The shunt function test revealed a VPS malfunction. Thus, we conducted VPS revision in this patient. All symptoms improved immediately after the revision. Thus, it is proposed that IIH should be considered for patients with visual disturbance and severe headache after VPS due to infant hydrocephalus without ventriculomegaly.
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Malem A, Sheth T, Muthusamy B. Paediatric Idiopathic Intracranial Hypertension (IIH)-A Review. Life (Basel) 2021; 11:life11070632. [PMID: 34209834 PMCID: PMC8307434 DOI: 10.3390/life11070632] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 06/08/2021] [Accepted: 06/23/2021] [Indexed: 12/16/2022] Open
Abstract
Paediatric idiopathic intracranial hypertension (IIH), is a rare but important differential diagnosis in children presenting with papilloedema. It is characterised by raised intracranial pressure in the absence of an identifiable secondary structural or systemic cause and is, therefore, a diagnosis of exclusion. In the adult population, there is a strong predilection for the disease to occur in female patients who are obese. This association is also seen in paediatric patients with IIH but primarily in the post-pubertal cohort. In younger pre-pubertal children, this is not the case, possibly reflecting a different underlying disease aetiology and pathogenesis. Untreated IIH in children can cause significant morbidity from sight loss, chronic headaches, and the psychological effects of ongoing regular hospital monitoring, interventions, and medication. The ultimate goal in the management of paediatric IIH is to protect the optic nerve from papilloedema-induced optic neuropathy and thus preserve vision, whilst reducing the morbidity from other symptoms of IIH, in particular chronic headaches. In this review, we will outline the typical work-up and diagnostic process for paediatric patients with suspected IIH and how we manage these patients.
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Martín-Begué N, Mogas E, Dod CW, Alarcón S, Clemente M, Campos-Martorell A, Fábregas A, Yeste D. Growth Hormone Treatment and Papilledema: A Prospective Pilot Study. J Clin Res Pediatr Endocrinol 2021; 13:146-151. [PMID: 33006547 PMCID: PMC8186341 DOI: 10.4274/jcrpe.galenos.2020.2020.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 09/16/2020] [Indexed: 12/01/2022] Open
Abstract
Objective To investigate the incidence of pseudotumor cerebri syndrome (PTCS) in children treated with growth hormone (GH) in a paediatric hospital and to identify risk factors for this complication. Methods Prospective pilot study of paediatric patients treated with recombinant human GH, prescribed by the Paediatric Endocrinology Department, between February 2013 and September 2017. In all these patients, a fundus examination was performed before starting treatment and 3-4 months later. Results Two hundred and eighty-nine patients were included, of whom 244 (84.4%) had GH deficiency, 36 (12.5%) had short stature associated with small for gestational age, six (2.1%) had a mutation in the SHOX gene and three (1.0%) had Prader-Willi syndrome. Five (1.7%) developed papilledema, all were asymptomatic and had GH deficiency due to craniopharyngioma (n=1), polymalformative syndrome associated with hypothalamic-pituitary axis anomalies (n=2), a non-specified genetic disease with hippocampal inversion (n=1) and one with normal magnetic resonance imaging who had developed a primary PTCS years before. Conclusion GH treatment is a cause of PTCS. In our series, at risk patients had GH deficiency and hypothalamic-pituitary anatomic anomalies or genetic or chromosomal diseases. Fundus examination should be systematically screened in all patients in this at-risk group, irrespective of the presence or not of symptoms.
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Affiliation(s)
- Nieves Martín-Begué
- Hospital Universitari Vall d’Hebron, Department of Paediatric Ophthalmology, Barcelona, Spain
| | - Eduard Mogas
- Hospital Universitari Vall d’Hebron, Department of Paediatric Endocrinology, Barcelona, Spain
| | - Charlotte Wolley Dod
- Hospital Universitari Vall d’Hebron, Department of Paediatric Ophthalmology, Barcelona, Spain
| | - Silvia Alarcón
- Hospital Universitari Vall d’Hebron, Department of Paediatric Ophthalmology, Barcelona, Spain
| | - María Clemente
- Hospital Universitari Vall d’Hebron, Department of Paediatric Endocrinology, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Centro de Investigación Biomédica en Red: Enfermedades Raras (CIBERER), Madrid, Spain
| | - Ariadna Campos-Martorell
- Hospital Universitari Vall d’Hebron, Department of Paediatric Endocrinology, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ana Fábregas
- Hospital Universitari Vall d’Hebron, Department of Paediatric Endocrinology, Barcelona, Spain
| | - Diego Yeste
- Hospital Universitari Vall d’Hebron, Department of Paediatric Endocrinology, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Centro de Investigación Biomédica en Red: Enfermedades Raras (CIBERER), Madrid, Spain
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Alkoht A, Alhariry H, Hanafi I, Aboud M. Idiopathic intracranial hypertension with juvenile idiopathic arthritis-associated uveitis: A case report. Clin Case Rep 2021; 9:e04281. [PMID: 34194789 PMCID: PMC8222758 DOI: 10.1002/ccr3.4281] [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: 11/22/2020] [Revised: 03/19/2021] [Accepted: 03/21/2021] [Indexed: 11/23/2022] Open
Abstract
A 14-year-old girl with juvenile idiopathic arthritis (JIA)-associated uveitis who also had optic disc edema, was later diagnosed with Idiopathic intracranial hypertension (IIH). To our knowledge, this is the fifth case of the coexistence of uveitis and IIH among children, and the only one with no obvious risk factors for IIH.
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Affiliation(s)
- Asaad Alkoht
- Faculty of MedicineDivision of RheumatologyDepartment of Internal MedicineDamascus UniversityDamascusSyria
| | - Huda Alhariry
- Faculty of MedicineDivision of RheumatologyDepartment of Internal MedicineDamascus UniversityDamascusSyria
| | - Ibrahem Hanafi
- Faculty of MedicineDivision of NeurologyDepartment of Internal MedicineDamascus UniversityDamascusSyria
| | - Majed Aboud
- Faculty of MedicineDivision of RheumatologyDepartment of Internal MedicineDamascus UniversityDamascusSyria
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Mohammed MA, Doheim MF, Allam IY. Optic nerve sheath fenestration in leukemic patients having increased intracranial pressure: a prospective clinical trial. Int Ophthalmol 2021; 41:3261-3268. [PMID: 34019192 DOI: 10.1007/s10792-021-01887-x] [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: 10/28/2020] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aimed to assess the safety and efficacy of optic nerve sheath fenestration (ONSF) in leukemic children having increased intracranial pressure with severe uncontrolled visual loss on medical treatment and not eligible for venous sinus stenting. METHODS In this non-randomized clinical trial, we included patients presenting with severe sight-threatening papilledema due to increased intracranial pressure following leukemia treatment. All included patients were subjected to a complete history taking, assessment of the visual acuity and fundus examination with fundus photography and grading of papilledema using Frisen scale. Patients were evaluated at 2 weeks and 3 months postoperative by recording the best-corrected visual acuity, assessment of the pupillary reaction and fundus examination and fundus photography with grading of papilledema. RESULTS Among 20 patients included in this study, there was a statistically significant improvement in visual acuity of both eyes in all patients. The mean postoperative visual acuity was 0.28 ± 0.10 two weeks after surgery in the right eye and it was 0.42 ± 0.16 in the left eye. The mean visual acuity in the right eye three months after surgery was 0.78 ± 0.19 and it was 0.87 ± 0.17 in the left eye. Three months postoperatively, papilledema resolved completely in both eyes. There were no recorded ocular complications. CONCLUSION In this study, ONSF was sight-saving procedure in all leukemic patients with a significant improvement in the visual acuity, stabilization of the visual function and resolving of the papilledema over follow-up period. There were no recorded intraoperative or postoperative complications. Further well-designed studies are needed to assert upon these results.
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Affiliation(s)
- Mai A Mohammed
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed Fahmy Doheim
- Faculty of Medicine, El-Khartoum Square, El Azareeta Medical Campus, Alexandria University, Champollion Street, Alexandria, 21131, Egypt.
| | - Ibrahim Y Allam
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Humphries LS, Swanson JW, Bartlett SP, Taylor JA. Craniosynostosis: Posterior Cranial Vault Remodeling. Clin Plast Surg 2021; 48:455-471. [PMID: 34051898 DOI: 10.1016/j.cps.2021.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Posterior cranial vault distraction osteogenesis is a powerful, reliable, low-morbidity method to achieve intracranial expansion. It is particularly useful in treating turribrachycephaly seen in syndromic craniosynostosis, allowing for gradual expansion of the bone while stretching the soft tissues over several weeks allowing greater volumetric expansion than conventional techniques. Posterior cranial vault distraction osteogenesis constitutes a more gradual remodeling modality, with infrequent complications. As a first step in intracranial expansion, it preserves the frontal cranium for future frontofacial procedures. A drawback is the need for a second surgery to remove the device, and this must be taken into account during counseling.
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Affiliation(s)
- Laura S Humphries
- Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Children's of Mississippi Hospital, 2500 N. State Street, Jackson, MS 39216, USA. https://twitter.com/ls_humphries
| | - Jordan W Swanson
- Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Scott P Bartlett
- Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Jesse A Taylor
- Division of Plastic and Reconstructive Surgery, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Flores AR, Pajer HB, Goh JL, Quinsey CS. Infantile idiopathic intracranial hypertension in the setting of recent laminectomy and filum lysis for tethered cord syndrome: a case report and literature review. Childs Nerv Syst 2021; 37:1373-1376. [PMID: 32748011 DOI: 10.1007/s00381-020-04827-9] [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: 04/22/2020] [Accepted: 07/21/2020] [Indexed: 11/24/2022]
Abstract
We present an 8-month old male status post simple tethered cord release with idiopathic intracranial hypertension.
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Affiliation(s)
- Alex R Flores
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Hengameh B Pajer
- Campbell University School of Osteopathic Medicine, Buies Creek, NC, USA
| | - Jo Ling Goh
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Carolyn S Quinsey
- Department of Neurosurgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
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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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Govil-Dalela T, Sivaswamy L. Diagnosing Pseudotumor Cerebri: An Age-based Approach. Pediatr Neurol Briefs 2020; 34:19. [PMID: 33354101 PMCID: PMC7747552 DOI: 10.15844/pedneurbriefs-34-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Investigators from Hillel-Yaffe, Carmel, and Bnai Zion Medical Centers in Israel studied the comparative clinical presentations and predisposing factors for idiopathic intracranial hypertension (IIH) across age groups
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Affiliation(s)
- Tuhina Govil-Dalela
- Department of Child Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
| | - Lalitha Sivaswamy
- Department of Child Neurology, Children's Hospital of Michigan, Wayne State University, Detroit, MI
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39
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Interlandi E, Pellegrini F, De Luca M, Cerullo G, De Falco A, De Marco R, Tortori A, Lee AG. Complete bilateral ophthalmoplegia in malignant intracranial hypertension in a child. Eur J Ophthalmol 2020; 32:1120672120966562. [PMID: 33081535 DOI: 10.1177/1120672120966562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe a case of fulminant idiopathic intracranial hypertension (IIH) in a child with "malignant" presentation. CASE REPORT A 16-year-old, previously healthy, girl presented with bilateral visual loss and bilateral global limitation of eye movements in the absence of headache. Extensive laboratory evaluation for infectious, inflammatory, autoimmune, and neoplastic conditions was negative. Magnetic resonance imaging (MRI) of the brain and lumbar puncture findings were consistent with a diagnosis of IIH. Extraocular motility improved in the next few days as well as optic disc edema but visual acuity remained poor. CONCLUSION The authors believe that the acute, severe, and fulminant ("malignant") presentation with markedly elevated intracranial pressure may produce the unique presentation of severe vision loss and bilateral complete ophthalmoplegia. Interestingly, there was no headache. To our knowledge this is the first such case to be reported in the English language ophthalmic literature.
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Affiliation(s)
- Emanuela Interlandi
- Department of Ophthalmology, "Ospedale del Mare", ASL Napoli 1-Centro, Naples, Campania, Italy
| | | | - Marco De Luca
- Department of Ophthalmology, "Ospedale del Mare", ASL Napoli 1-Centro, Naples, Campania, Italy
| | - Giovanni Cerullo
- Department of Neurology, "Ospedale del Mare", ASL Napoli 1-Centro, Naples, Campania, Italy
| | - Arturo De Falco
- Department of Neurology, "Ospedale del Mare", ASL Napoli 1-Centro, Naples, Campania, Italy
| | - Rocco De Marco
- Department of Ophthalmology, "Ospedale del Mare", ASL Napoli 1-Centro, Naples, Campania, Italy
| | - Achille Tortori
- Department of Ophthalmology, "Ospedale del Mare", ASL Napoli 1-Centro, Naples, Campania, Italy
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, TX, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, NY, USA
- Departments of Ophthalmology, The University of Texas Medical Branch (UTMB), Galveston, TX, USA
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Texas A&M College of Medicine, College Station, TX, USA
- Baylor College of Medicine, Center for Space Medicine, Houston, TX, USA
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
- University at Buffalo, Buffalo, NY, USA
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40
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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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McTaggart JS, Lalou AD, Higgins NJ, Chitre M, Parker APJ, Muthusamy B, Czosnyka ZH, Krishnakumar D. Correlation between the total number of features of paediatric pseudotumour cerebri syndrome and cerebrospinal fluid pressure. Childs Nerv Syst 2020; 36:2003-2011. [PMID: 32123999 DOI: 10.1007/s00381-020-04537-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 02/08/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE Accurate diagnosis of pseudotumour cerebri syndrome (PTCS) in children is challenging. We aimed to see if the clinical and radiological assessment that is carried out before lumbar puncture could predict subsequently recorded CSF pressures, and thus whether it could be used to increase diagnostic certainty of paediatric PTCS. METHODS We used internationally recognised diagnostic criteria to derive a list of clinical, brain neuroimaging and venography features that were accepted to be associated with a diagnosis of PTCS. We performed a retrospective cohort study of children referred to our centre with suspected PTCS, identifying the presence or absence of those features for each child at initial presentation. The sum total scores of the features that were present were correlated with the child's recorded CSF pressure. RESULTS The sum total scores were significantly positively correlated with recorded CSF pressures. The positive correlation was seen when clinical and brain neuroimaging features were included alone, and the correlation was slightly stronger when venography features were included in addition. CONCLUSION Calculating the sum total of clinical, brain neuroimaging and venography features (where venography is performed) present at initial presentation can help in the management of children under investigation for PTCS. Children with high scores are more likely to have severely raised CSF pressures and thus may warrant more urgent LP investigations. By contrast, in children with subtle abnormalities in optic disc appearance such that disc oedema cannot be ruled out, a low score may add further reassurance and less urgency to proceed to LP.
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Affiliation(s)
- James S McTaggart
- Paediatric Neurology, Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Afroditi-Despina Lalou
- Clinical Neurosciences, Division of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Nicholas J Higgins
- Neuroradiology, Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Manali Chitre
- Paediatric Neurology, Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Alasdair P J Parker
- Paediatric Neurology, Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Brinda Muthusamy
- Paediatric Ophthalmology, Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Zofia H Czosnyka
- Clinical Neurosciences, Division of Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK
| | - Deepa Krishnakumar
- Paediatric Neurology, Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
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Verkuil LD, Liu GT, Brahma VL, Avery RA. Pseudotumor cerebri syndrome associated with MIS-C: a case report. Lancet 2020; 396:532. [PMID: 32795406 DOI: 10.1016/s0140-6736(20)31725-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/01/2020] [Accepted: 08/03/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Lana D Verkuil
- Scheie Eye Institute, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, PA 19104, USA.
| | - Grant T Liu
- Neuro-ophthalmology Service of the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Venkatesh L Brahma
- Neuro-ophthalmology Service of the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Robert A Avery
- Neuro-ophthalmology Service of the Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania, University of Pennsylvania Health System, Philadelphia, PA, USA
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Influence of Optic Nerve Appearance on Visual Outcome in Pediatric Idiopathic Intracranial Hypertension. Can J Neurol Sci 2020; 47:661-665. [PMID: 32362301 DOI: 10.1017/cjn.2020.89] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To determine whether optic disc hemorrhages (ODH) and cotton wool spots (CWS) at presentation are associated with worse visual outcomes in pediatric patients with idiopathic intracranial hypertension (IIH). METHODS Retrospective institutional review of 100 eyes of 50 consecutive pediatric IIH patients (aged 16 years or less) who had baseline optic disc photographs before or within 30 days of their diagnostic lumbar puncture and initiation of medical treatment. Optic disc photographs were independently graded by three ophthalmologists in a standardized manner. Visual function was assessed using visual acuity (VA) and visual field grade (VFG). RESULTS At least one ODH was found in 41% of eyes, at least one CWS was found in 27% of eyes, and 20% of eyes had both ODH and CWS. At presentation, Frisén grade was associated with the presence of CWS (p = 0.013) and showed no association with ODH (p = 0.060). When controlling for Frisén grade, ODH and CWS were not associated with worse VA or VFG at final follow-up. Severe ODH were associated with worse VA and VFG at presentation (p < 0.03), but not at final follow-up. Severe CWS at presentation was strongly associated with a worse Humphrey mean deviation of 5.0 dB (95% confidence interval 1.6-8.3) at final follow-up (p = 0.002). CONCLUSION When controlling for the severity of papilledema, ODH do not provide any additional prognostic value in pediatric IIH patients. Frisén grade and severe CWS at presentation were independently associated with worse visual outcomes at the final follow-up.
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Bashiri FA, Al Abdulsalam HK, Hassan SM, Al Twaijri WA, Almalki FI, Kentab AY, Hamad MH, Alwadei AH, Al-Showaeir DA, Altweijri IS, Aldabjan HM, Aldegether MS, Albakr AA, Alhothali WM, Ajlan AM, Hassan HH, Salih MA. Pediatric intracranial hypertension. Experience from 2 Tertiary Centers. ACTA ACUST UNITED AC 2020; 24:257-263. [PMID: 31872803 PMCID: PMC8015550 DOI: 10.17712/nsj.2019.4.20190052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To review the experience of 2 tertiary centers in Saudi Arabia with intracranial hypertension (IH) in the pediatric population. METHODS We retrospectively reviewed and analyzed pediatric patients diagnosed with IH from June 2002 to May 2017 in 2 institutes. RESULTS We identified 53 patients (30 females and 23 males) with a mean age of 7 years at the time of presentation. Among them, 41 patients were younger than 12 years, and 12 were older. Obese and overweight patients constituted 27.00% (n = 14) of all cases, 8 (66.7%) of whom were older than 12 years. The most common presenting feature was papilledema followed by headache. Vitamin D deficiency, which constituted the most common associated condition, was identified in 12 (22.6%) patients. Acetazolamide was the treatment option in 98.11% of patients, and only 5.7% underwent surgical interventions. The length of follow-up ranged from 6 months to 8 years. CONCLUSION Intracranial hypertension is rare in children and commonly seen in overweight females older than 12 years similar to adults. Patients younger than 12 years tend to develop secondary IH. More studies are needed to characterize the clinical presentation and guide the management plan.
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Affiliation(s)
- Fahad A Bashiri
- Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail:
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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: 15] [Impact Index Per Article: 3.8] [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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Intracranial pressure patterns in children with craniosynostosis utilizing optical coherence tomography. Childs Nerv Syst 2020; 36:535-544. [PMID: 31848721 DOI: 10.1007/s00381-019-04448-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 11/19/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Better understanding the incidence and patterns of elevated intracranial pressure (ICP) in patients with craniosynostosis may facilitate more timely intervention to alter neurocognitive outcomes. Spectral-domain optical coherence tomography (OCT) of the retina can non-invasively diagnose elevated ICP, and has demonstrated high sensitivity and specificity among patients with craniosynostosis. This study sought to characterize patterns of elevated ICP among patients with craniosynostosis. METHODS Quantitative retinal parameters were prospectively assessed in both eyes of patients with craniosynostosis using spectral-domain OCT. Based on retinal OCT thresholds associated with elevated ICP (> 15 mmHg), subjects were assigned an OCT diagnosis of elevated or non-elevated ICP which was analyzed relative to clinical characteristics and craniosynostosis patterns. RESULTS Eighty subjects (aged 0.2-18 years) with craniosynostosis were enrolled; among these, 67 (84%) were nonsyndromic. OCT evaluation was performed at initial vault expansion in 56 (70%) patients. Among this subset, 27 (48%) patients had peri-papillary changes suggestive of elevated ICP, reflecting a 44% incidence in nonsyndromic and 83% in syndromic patients. The median age at initial vault expansion was higher among those with elevated ICP (11.1 months) than those without (7.8 months; p = 0.04.) Multi-suture synostosis was associated with changes consistent with elevated ICP in 9 (75%) patients compared with 18 (41%) with single suture synostosis (p = 0.05). CONCLUSIONS OCT of the retina produces a potentially sensitive indicator of ICP in craniosynostosis patients. Elevated ICP may be associated with number of involved sutures and older patient presentation, and refining appropriate "cutoffs" will be important as the technology becomes more widespread.
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Doxaki C, Papadopoulou E, Maniadaki I, Tsakalis NG, Palikaras K, Vorgia P. Case Report: Intracranial Hypertension Secondary to Guillain-Barre Syndrome. Front Pediatr 2020; 8:608695. [PMID: 33553071 PMCID: PMC7857149 DOI: 10.3389/fped.2020.608695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/18/2020] [Indexed: 11/13/2022] Open
Abstract
Guillain-Barre Syndrome (GBS), a common cause of acute flaccid paralysis, is characterized by a rapidly progressive, usually symmetric weakness of the extremities. Headache and intracranial hypertension (ICHT) are very rare complications of GBS. Herein we report our current case of an obese girl with typical signs of GBS associated with autonomic dysfunction, cranial nerve deficits and increased intracranial pressure (ICP). We also perform a systematic study presenting and discussing previous case reports of GBS associated with ICHT, papilledema or hydrocephalus, highlighting the differences of the current case compared to previous studies. Although intracranial hypertension is a rare complication of pediatric GBS, clinicians should promptly detect it. Obesity may be a predisposing factor, given the strong association between idiopathic intracranial hypertension (IIH) and weight gain. Neurological evaluation, fundus examination and low threshold for intracranial imaging should be an integral part of medical practice in case of obesity, headache or visual changes in GBS patients.
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Affiliation(s)
- Christina Doxaki
- Department of Pediatrics, University General Hospital of Heraklion, Crete, Greece
| | | | - Iliana Maniadaki
- Department of Pediatrics, University General Hospital of Heraklion, Crete, Greece
| | - Nikolaos G Tsakalis
- Department of Ophthalmology, University General Hospital of Heraklion, Crete, Greece
| | - Konstantinos Palikaras
- Institute of Molecular Biology and Biotechnology (IMBB), Foundation for Research and Technology - Hellas (FORTH), Crete, Greece
| | - Pelagia Vorgia
- Department of Pediatrics, University General Hospital of Heraklion, Crete, Greece
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Abouhashem S, Gad AAM, El-Malkey M, Daoud EA. Idiopathic intracranial hypertension in pediatric and adolescent patients. EGYPTIAN JOURNAL OF NEUROSURGERY 2019. [DOI: 10.1186/s41984-019-0058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Objectives
Pediatric idiopathic intracranial hypertension is a rare condition, but inappropriate diagnosis and management may lead to devastating outcome with loss of vision and lifelong handicap. Dandy criteria are used for diagnosis of idiopathic intracranial hypertension (IIH) in adult, but these criteria cannot be applied in all pediatric patients.
The aim of this study is to evaluate the diagnostic criteria and outcome of management of IIH in pediatric patients.
Methods
Nineteen patients with IIH and age less than 16 years old have been evaluated for the diagnostic criteria and outcome of management. The patients were classified according to the secondary sexual criteria into adolescent IIH and pediatric IIH. Full neurological and ophthalmological evaluation was completed in all patients. The patients were managed and followed up for a mean period of 12 ± 8.6 months at Zagazig University hospitals or Kingdom Hospital in the time period from 2009 to 2018.
Results
Nineteen patients (16 females and 3 males) had been diagnosed and treated with idiopathic intracranial hypertension, their age is between 4 and 15 years, and the patients have been divided into two groups. Group I (pediatric IIH) involved 9 patients (6 females and 3 males), and their age is ranging between 4 and 9 years with mean age 5.56 ± 1.9 years while group II (adolescent IIH) involved 10 patients, all of them are females and their age ranges between 12 and 15 years with mean age 13.5 ± 1.3. Diagnostic criteria of the patients are papilledema, symptoms and signs of intracranial hypertension, and elevated CSF opening pressure with normal MRI. Headache, delayed school performance, and sixth nerve palsy are the most common clinical finding in the patients of group I while headache is the most common presenting symptom in group II. Anemia and otitis media are the most common associated risk factors in group I while obesity and female gender were the most common associated risk factors in group II. The minimum value for opening pressure in group I is 180 mmH2O while the minimum value in group II is 250 mm. 16 patients improved after the first lumbar puncture and drainage of CSF; two patients improved after repeated lumbar puncture while lumbo-peritoneal shunt was inserted for two patients, both of them were in group II. Recurrence was diagnosed in four patients (21%), one of them (11.1%) was in group I while three of them (30%) were in group II.
Conclusion
Pediatric idiopathic intracranial hypertension can be classified into two subtypes: pediatric type and adolescent type according to the secondary sexual criteria.
Modified Dandy criteria can be applied for the diagnosis of adolescent type, but pediatric type is not associated with obesity, has no female predominance, and usually responds to the initial lumbar puncture with a low rate of recurrence.
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Frija LMT, Ntungwe E, Sitarek P, Andrade JM, Toma M, Śliwiński T, Cabral L, S. Cristiano ML, Rijo P, Pombeiro AJL. In Vitro Assessment of Antimicrobial, Antioxidant, and Cytotoxic Properties of Saccharin-Tetrazolyl and -Thiadiazolyl Derivatives: The Simple Dependence of the pH Value on Antimicrobial Activity. Pharmaceuticals (Basel) 2019; 12:E167. [PMID: 31726663 PMCID: PMC6958446 DOI: 10.3390/ph12040167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 02/07/2023] Open
Abstract
The antimicrobial, antioxidant, and cytotoxic activities of a series of saccharin-tetrazolyl and -thiadiazolyl analogs were examined. The assessment of the antimicrobial properties of the referred-to molecules was completed through an evaluation of minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) values against Gram-positive and Gram-negative bacteria and yeasts. Scrutiny of the MIC and MBC values of the compounds at pH 4.0, 7.0, and 9.0 against four Gram-positive strains revealed high values for both the MIC and MBC at pH 4.0 (ranging from 0.98 to 125 µg/mL) and moderate values at pH 7.0 and 9.0, exposing strong antimicrobial activities in an acidic medium. An antioxidant activity analysis of the molecules was performed by using the DPPH (2,2-diphenyl-1-picrylhydrazyl) method, which showed high activity for the TSMT (N-(1-methyl-2H-tetrazol-5-yl)-N-(1,1-dioxo-1,2-benzisothiazol-3-yl) amine, 7) derivative (90.29% compared to a butylated hydroxytoluene positive control of 61.96%). Besides, the general toxicity of the saccharin analogs was evaluated in an Artemia salina model, which displayed insignificant toxicity values. In turn, upon an assessment of cell viability, all of the compounds were found to be nontoxic in range concentrations of 0-100 µg/mL in H7PX glioma cells. The tested molecules have inspiring antimicrobial and antioxidant properties that represent potential core structures in the design of new drugs for the treatment of infectious diseases.
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Affiliation(s)
- Luís M. T. Frija
- Centro de Química Estrutural (CQE), Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal;
| | - Epole Ntungwe
- CBIOS—Research Center for Health Sciences & Technologies, ULusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal; (E.N.); (J.M.A.)
| | - Przemysław Sitarek
- Department of Biology and Pharmaceutical Botany, Medical University of Lodz, Muszyńskiego Street 1, 90-151 Łódź, Poland;
| | - Joana M. Andrade
- CBIOS—Research Center for Health Sciences & Technologies, ULusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal; (E.N.); (J.M.A.)
| | - Monika Toma
- Laboratory of Medical Genetics, Faculty of Biology and Environmental Protection, University of Lodz, 90-151 Lodz, Poland; (M.T.); (T.Ś.)
| | - Tomasz Śliwiński
- Laboratory of Medical Genetics, Faculty of Biology and Environmental Protection, University of Lodz, 90-151 Lodz, Poland; (M.T.); (T.Ś.)
| | - Lília Cabral
- Department of Chemistry and Pharmacy (FCT) and Center of Marine Sciences (CCMar), Universidade do Algarve, P-8005-039 Faro, Portugal; (L.C.); (M.L.S.C.)
| | - M. Lurdes S. Cristiano
- Department of Chemistry and Pharmacy (FCT) and Center of Marine Sciences (CCMar), Universidade do Algarve, P-8005-039 Faro, Portugal; (L.C.); (M.L.S.C.)
| | - Patrícia Rijo
- CBIOS—Research Center for Health Sciences & Technologies, ULusófona de Humanidades e Tecnologias, Campo Grande 376, 1749-024 Lisboa, Portugal; (E.N.); (J.M.A.)
- iMed.ULisboa - Research Institute for Medicines, Faculdade de Farmácia, Universidade de Lisboa, Av. Prof. Gama Pinto, 1649-003 Lisboa, Portugal
| | - Armando J. L. Pombeiro
- Centro de Química Estrutural (CQE), Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisboa, Portugal;
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Magnetic Resonance Imaging Findings in Pediatric Pseudotumor Cerebri Syndrome. Pediatr Neurol 2019; 99:31-39. [PMID: 31303369 PMCID: PMC6890473 DOI: 10.1016/j.pediatrneurol.2019.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/13/2019] [Accepted: 04/18/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Revised diagnostic criteria for pseudotumor cerebri syndrome require three of four neuroimaging findings in the absence of papilledema. We examined the sensitivity and specificity of three or more of four of these magnetic resonance imaging (MRI) findings for pseudotumor cerebri syndrome in children. METHODS As part of clinical care, patients in whom there was suspicion for pseudotumor cerebri syndrome underwent neurological and fundoscopic examinations, lumbar puncture, MRI, or magnetic resonance venogram. For this retrospective study, we used this information to classify 119 subjects into definite (n = 66) or probable pseudotumor cerebri syndrome (n = 12), elevated opening pressure without papilledema (n = 23), or controls who had normal opening pressure without papilledema (n = 24). A neuroradiologist, unaware of the clinical findings or original MRI report, reviewed MRIs for pituitary gland flattening, flattening of the posterior sclera, optic nerve sheath distention, and transverse venous sinus stenosis. RESULTS The presence of three or more MRI findings has a sensitivity of 62% (95% confidence interval: 47% to 75%) and a specificity of 95% (95% confidence interval: 77% to 100%), compared with controls. Two of three (transverse venous sinus stenosis, pituitary gland flattening, flattening of the posterior sclera) had a similar sensitivity and specificity. Transverse venous sinus stenosis alone had a slightly higher sensitivity (74%, 95% confidence interval: 60% to 85%) and specificity (100%, 95% confidence interval: 80% to 100%). CONCLUSIONS In children, three of four of the proposed neuroimaging criteria and transverse venous sinus stenosis alone have a moderate sensitivity and robust specificity for pseudotumor cerebri syndrome. MRIs should be reviewed for these criteria, and their presence should raise suspicion for pseudotumor cerebri syndrome in children, particularly if the presence of papilledema is uncertain.
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