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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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Tatar IT, Solmaz B, Erdem ZG, Pasaoglu I, Demircan A, Tülü Aygün B, Ozkaya A. Morphological assessment of lamina cribrosa in idiopathic intracranial hypertension. Indian J Ophthalmol 2020; 68:164-167. [PMID: 31856499 PMCID: PMC6951187 DOI: 10.4103/ijo.ijo_142_19] [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] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Purpose: Technological development of optic coherence tomography has enabled a detailed assessment of the optic nerve and deeper structures and in vivo measurements. The aim of this study was to compare the lamina cribrosa morphology of the optic nerve in idiopathic intracranial hypertension (IIH) and healthy individuals. Methods: The lamina cribrosa morphology of optic nerve in 15 eyes with IIH and 17 eyes of healthy individuals were compared. Four parameters such as Bruch membrane opening (BMO), lamina cribrosa thickness (LCT), prelaminar tissue thickness (PTT), and anterior lamina cribrosa surface depth (ALCSD) were retrospectively evaluated. Results: By enhanced depth imaging-optic coherence tomography (EDI-OCT), PTT and BMO were found to be significantly greater (574,35 ± 169,20 μm and 1787,40 ± 140,87 μm, respectively) in IIH patients than healthy individuals (187,18 ± 132,15 μm and 1632,65 ± 162,58 μm, respectively), whereas ALSCD was found to be significantly less in IIH patients (234,49 ± 49,31 μm) than healthy individuals (425,65 ± 65,23 μm). There was not a statistically significant difference regarding LCT between the IIH patients (238,59 ± 17,31 μm) and healthy individuals (244,96 ± 15,32 μm). Conclusion: Increased intracranial pressure causes morphological changes in lamina cribrosa. Assessment of lamina cribrosa with EDI-OCT is important for diagnosis and follow-up of patients with IIH. EDI-OCT is objective, reproducible, and cost-effective assistive imaging tool in IIH patients.
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Affiliation(s)
| | - Banu Solmaz
- Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | | | - Isıl Pasaoglu
- Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | - Ali Demircan
- Beyoglu Eye Research and Training Hospital, Istanbul, Turkey
| | | | - Abdullah Ozkaya
- Department of Ophthalmology, İstanbul Aydin University Medical School, Surp Pirgic Armenian Hospital, Istanbul, Turkey
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Kisabay A, Selcuki D, Zeybek S, Batum M. Evaluation of the patients diagnosed as idiopathic intracranial hypertension with and without papilledema visual pathways by analysis of visual evoked potential. Int J Neurosci 2020; 131:183-190. [DOI: 10.1080/00207454.2020.1736581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Ayşin Kisabay
- Department of Neurology, Celal Bayar University, Manisa, Turkey
| | - Deniz Selcuki
- Department of Neurology, Celal Bayar University, Manisa, Turkey
| | - Sinem Zeybek
- Department of Neurology, Celal Bayar University, Manisa, Turkey
| | - Melike Batum
- Department of Neurology, Celal Bayar University, Manisa, Turkey
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Fernández-García MÁ, Cantarín-Extremera V, Andión-Catalán M, Duat-Rodríguez A, Jiménez-Echevarría S, Bermejo-Arnedo I, Hortigüela-Saeta M, Rekarte-García S, Babín-López L, Ruano Domínguez D. Secondary Intracranial Hypertension in Pediatric Patients With Leukemia. Pediatr Neurol 2017; 77:48-53. [PMID: 29097019 DOI: 10.1016/j.pediatrneurol.2017.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND We investigated the clinical characteristics of a pediatric population with hemato-oncological disease and intracranial hypertension, analyze the therapeutic response and outcome, and compare its characteristics with respect to a control group with idiopathic intracranial hypertension. METHODS We retrospectively analyzed patients with hemato-oncological disease and secondary intracranial hypertension in our center during the past five years. We compared these individuals with a historical cohort with idiopathic intracranial hypertension from our institution (control group). RESULTS We identified eight patients, all with leukemia, and 21 controls. Mean age at diagnosis was 10.6 years, and 62% of individuals were female. Most of them were under treatment with drugs (62% corticosteroids, 75% active chemotherapy). Mean opening pressure of cerebrospinal fluid was 35 cm H2O. All had headache, but only 28% complained of visual symptoms. Only 12.5% exhibited papilledema at the time of diagnosis (versus 71% in controls). All of them were treated with acetazolamide, with average therapy duration of nine months, and all had a favorable outcome (versus 57% of controls who needed second-line treatment). None of them showed long-term visual complications (versus 20% of controls). CONCLUSIONS Patients with hemato-oncological disease and secondary intracranial hypertension may not develop typical symptomatology. Thus, diagnosis and recognition of this entity among this cohort may be difficult. Associated factors are diverse and do not show an obvious causal relationship. A high index of suspicion must be maintained for diagnosis, because a favorable outcome is expected with prompt treatment. Acetazolamide is effective as a first-line therapy and caused few side effects.
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Affiliation(s)
| | | | - Maitane Andión-Catalán
- Pediatric Hemato-Oncology Section, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Anna Duat-Rodríguez
- Pediatric Neurology Section, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | | | - Saray Rekarte-García
- Pediatric Neurology Section, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Lara Babín-López
- Pediatric Neurology Section, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - David Ruano Domínguez
- Pediatric Hemato-Oncology Section, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Marvin E, Synkowski J, Benko M. Tumor cerebri: Metastatic renal cell carcinoma with dural venous sinus compression leading to intracranial hypertension; a case report. Surg Neurol Int 2017; 8:175. [PMID: 28868187 PMCID: PMC5569408 DOI: 10.4103/sni.sni_69_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/07/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Pseudotumor cerebri (PTC), also known as idiopathic intracranial hypertension (IIH), is a condition associated with increased intracranial pressure (ICP) in the absence of radiographic findings such as mass lesions or cerebral edema. CASE DESCRIPTION We describe a case of progressive headache and visual disturbances attributed to PTC that resulted from subacute superior sagittal sinus (SSS) stenosis by a metastatic tumor. CONCLUSIONS Venous outflow obstruction often presents with an acute symptomatology including infarcts, hemorrhages, and seizures, but only rarely does it cause the progressive development of raised ICP. The sinister presentation of our patient's pathology stemmed from local mass effect caused by a tumor that has hitherto not been reported to cause intracranial hypertension (IH) and was best elucidated using magnetic resonance venography (MRV).
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Affiliation(s)
- Eric Marvin
- Department of Neurosurgery, Institute for Orthopaedics and Neurosciences, Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, Virginia, USA
| | - Jordan Synkowski
- Department of Neurosurgery, Institute for Orthopaedics and Neurosciences, Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, Virginia, USA
| | - Michael Benko
- Department of Neurosurgery, Institute for Orthopaedics and Neurosciences, Virginia Tech Carilion School of Medicine and Research Institute, Roanoke, Virginia, USA
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Peng KP, Fuh JL, Wang SJ. High-pressure headaches: idiopathic intracranial hypertension and its mimics. Nat Rev Neurol 2012; 8:700-10. [DOI: 10.1038/nrneurol.2012.223] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Degnan AJ, Levy LM. Pseudotumor cerebri: brief review of clinical syndrome and imaging findings. AJNR Am J Neuroradiol 2011; 32:1986-93. [PMID: 21680652 PMCID: PMC7964411 DOI: 10.3174/ajnr.a2404] [Citation(s) in RCA: 166] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PTC is a clinical entity of uncertain etiology characterized by intracranial hypertension. The syndrome classically manifests with headaches and visual changes in women with obesity. Traditionally, imaging ruled out secondary causes of elevated CSF pressure but now may reveal findings frequently seen in patients with PTC, including the following: flattening of the globe, an empty sella, an enlarged ONS, protrusion and enhancement of the optic nerve head, and increased tortuosity of the optic nerve. Novel imaging methods, including MR venography, have additionally identified sinovenous stenosis as a potential indicator of PTC.
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Affiliation(s)
- A J Degnan
- Department of Radiology, George Washington University Hospital, Washington, DC, USA
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Friesner D, Rosenman R, Lobb BM, Tanne E. Idiopathic intracranial hypertension in the USA: the role of obesity in establishing prevalence and healthcare costs. Obes Rev 2011; 12:e372-80. [PMID: 20804521 DOI: 10.1111/j.1467-789x.2010.00799.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study documents for the first time the extraordinary costs to take care of patients with a chronic, non-fatal, relatively rare disorder who have been incorrectly thought to have an insignificant and self-limiting illness. Idiopathic intracranial hypertension (IIH) occurs worldwide and in all racial groups and is found predominantly in obese women (∼ 90%) of childbearing age. Although the incidence of IIH is increasing as a result of the rapid increase in obesity, the disorder in general receives little recognition, and no recognition of the extensive burden of healthcare costs placed on patients, their families and society. We established for the first time both the prevalence of IIH in the USA and the direct and indirect costs of IIH using a prevalence-based model. IIH patients had an exceptionally high hospital admission rate of 38% (in 2007), a partial reflection of unsatisfactory treatment options. The total hospital costs per IIH admission in 2007 were four times greater than for a population-based per person admission. Total economic costs of IIH patients exceeded $444 million. Programmes designed to reduce obesity prior to and after diagnosis and better therapeutics will have a tremendous economic impact.
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Affiliation(s)
- D Friesner
- Department of Pharmacy Practice, North Dakota State University, Fargo, North Dakota, USA
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Spennato P, Ruggiero C, Parlato RS, Buonocore MC, Varone A, Cianciulli E, Cinalli G. Pseudotumor cerebri. Childs Nerv Syst 2011; 27:215-35. [PMID: 20721668 DOI: 10.1007/s00381-010-1268-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Accepted: 08/03/2010] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pseudotumor cerebri is a condition characterized by raised intracranial pressure, normal CSF contents, and normal brain with normal or small ventricles on imaging studies. It affects predominantly obese women of childbearing age; however, its incidence seems to be increasing among adolescent and children. While among older children the clinical picture is similar to that of adults, younger children present demographic and clinical peculiarities. Different diagnostic criteria for adults and pre-pubertal children have been proposed. Etiology and pathogenesis are still unclear, particular concerning the role of obstruction to venous outflow. METHODS An extensive literature review concerning all the aspects of pseudotumor cerebri has been performed, both among adults and pre-pubertal children. CONCLUSION Pseudotumor cerebri is an avoidable cause of visual loss, both in adults and children. Few diagnostic measures are usually sufficient to determine the correct diagnosis. Since pseudotumor cerebri is a diagnosis of exclusion, the differential diagnosis work out is of special importance. Modern neuroimaging techniques, especially magnetic resonance imaging and magnetic resonance venography may clarify the role of obstruction to venous outflow in each case. Various therapeutic options are available: medical, surgical, and endovascular procedures may be used to prevent irreversible visual loss. Treatment is usually effective, and most patients will experience complete resolution of symptoms without persistent deficits.
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Affiliation(s)
- Pietro Spennato
- Department of Neurosurgery, Santobono-Paulipon Pediatric Hospital, Via Mario Fiore 6, Naples, Italy.
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Bertelmann T, Sekundo W. Progrediente Erblindung einer jungen Patientin mit extremer Adipositas. Internist (Berl) 2010; 51:1190, 1192-5. [DOI: 10.1007/s00108-010-2613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Œdème papillaire bilatéral. Conduite diagnostique. J Fr Ophtalmol 2010; 33:424-9. [DOI: 10.1016/j.jfo.2010.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 02/17/2010] [Indexed: 11/21/2022]
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Ozdamar Y, Acaroglu G, Gokcek O. Localized Cystic Enlargement of the Distal Optic Nerve Sheath after Decompression Surgery. Ophthalmic Surg Lasers Imaging Retina 2010; 41:1-3. [PMID: 20337328 DOI: 10.3928/15428877-20100215-43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2009] [Indexed: 05/29/2023]
Abstract
Cystic formation of the optic meninges may occur after optic nerve sheath decompression surgery for the management of pseudotumor cerebri. A case with a cyst-like structure of the distal optic nerve sheath at the operation site in the late surgical period after nerve sheath decompression surgery is reported.
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Abstract
An optic nerve sheath fenestration is indicated when papilloedema leads to progressive visual loss despite previous, conservative measures and when no cause of increased intracranial pressure can be indentified and eliminated. This rather rare constellation usually occurs in idiopathic intracranial hypertension. The procedure is performed via a medial transconjunctival orbitotomy. If headaches and neurologic symptoms other than visual deterioration prevail, the placement of a ventricular shunt is preferred. This review covers the symptoms of idiopathic intracranial hypertension and optic nerve sheath fenestration with its technical aspects and results.
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Affiliation(s)
- W A Lagrèze
- Universitäts-Augenklinik Freiburg, Killianstrasse 5, 79106, Freiburg.
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Kesler A, Vakhapova V, Korczyn AD, Drory VE. Visual evoked potentials in idiopathic intracranial hypertension. Clin Neurol Neurosurg 2009; 111:433-6. [DOI: 10.1016/j.clineuro.2008.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 12/03/2008] [Accepted: 12/19/2008] [Indexed: 11/26/2022]
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Goyal S, Pless ML, Krishnamoorthy K, Butler WE, Noviski N, Gupta P. What's New in Childhood Idiopathic Intracranial Hypertension? Neuroophthalmology 2009. [DOI: 10.1080/01658100902717074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Pseudotumor cerebri: yet another reason to fight obesity. J Pediatr Health Care 2008; 22:40-3. [PMID: 18174088 DOI: 10.1016/j.pedhc.2007.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 05/02/2007] [Accepted: 05/02/2007] [Indexed: 11/22/2022]
Abstract
Pseudotumor cerebri, also referred to as idiopathic intracranial hypertension, is a syndrome characterized by increased intracranial pressure and excludes underlying structural or systemic causes. Pseudotumor cerebri/idiopathic intracranial hypertension has been reported commonly in obese young women but can occur in children and adolescents. With the rise in overweight children, it is important to include this condition as a differential diagnosis, particularly when patients present with complaints of headache.
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Abstract
Recent advancements in the speed and accuracy of data acquisition and resolution of neuroimaging and interventional techniques have revolutionized the early anatomical and functional diagnosis, prognosis, and treatment of many neuroophthalmological disorders. The relatively new techniques include magnetic resonance (MR) spectroscopy, computed tomography angiography, positron emission tomography, and functional MR imaging. In this paper the author describes the principles of the current techniques used by neuroophthalmologists and their value in the diagnosis, localization, and treatment of various afferent and efferent visual and ocular disorders.
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Affiliation(s)
- Swaraj Bose
- Department of Ophthalmology, University of California, Irvine, California 92697, USA.
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Esmaili N, Bradfield YS. Pseudotumor cerebri in children with Down syndrome. Ophthalmology 2007; 114:1773-8. [PMID: 17368546 DOI: 10.1016/j.ophtha.2006.12.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2006] [Revised: 12/12/2006] [Accepted: 12/12/2006] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To report 4 pediatric Down syndrome patients with optic nerve elevation and pseudotumor cerebri. DESIGN Retrospective observational case series. PARTICIPANTS Four pediatric Down syndrome patients found to have optic nerve elevation on ophthalmologic examination at a single institution. METHODS Medical record review of 117 pediatric Down syndrome patients aged 0 to 18 years was performed. All patients were seen at the University of Wisconsin pediatric ophthalmology clinic between 1995 and 2005. MAIN OUTCOME MEASURES Visual acuity, optic nerve appearance, and neurologic work-up. RESULTS Four (3.4%) of 117 Down syndrome patients seen at the university's pediatric ophthalmology clinic were found to have optic nerve elevation. This included 2 boys and 2 girls, aged 2 to 10 years. None of the patients had a history of headache or transient visual obscuration. One of the patients had high hyperopia at the time of presentation, and all were referred for neurologic evaluation of suspected increased intracranial pressure. Three patients were diagnosed with pseudotumor cerebri (PTC) based on a normal brain magnetic resonance imaging (MRI) scan, an elevated opening cerebrospinal fluid (CSF) pressure on lumbar puncture, and normal CSF analysis results. The fourth patient's elevated optic nerve appearance was likely secondary to PTC after obtaining normal brain MRI results; however, this patient did not undergo a lumbar puncture. One child with PTC demonstrated improvement in visual acuity and optic nerve appearance after acetazolamide and weight loss therapy. The 2 additional patients with PTC were treated with either low-dose acetazolamide or weight loss therapy and experienced optic atrophy. The final patient, who did not undergo lumbar puncture, experienced spontaneous resolution of optic nerve elevation. Mean follow-up duration was 49 months. CONCLUSIONS Only 3.4% (4/117) of Down syndrome children were found to have optic nerve elevation in a single institution. Pseudotumor cerebri should be considered in asymptomatic Down syndrome patients with elevated optic nerves. Medical therapy in PTC with acetazolamide can lead to improvement in visual acuity and optic nerve appearance, although optic atrophy also was seen.
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Affiliation(s)
- Neda Esmaili
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin 53705, USA
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Somech R, Doyle J. Pseudotumor cerebri after allogeneic bone marrow transplant associated with cyclosporine a use for graft-versus-host disease prophylaxis. J Pediatr Hematol Oncol 2007; 29:66-8. [PMID: 17230071 DOI: 10.1097/mph.0b013e318030ac3b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pseudotumor cerebri (PTC) is a syndrome of increased intracranial pressure for which several risk factors have been described. We report 2 patients who developed PTC after cyclosporine A (CsA) therapy for graft-versus-host disease (GvHD) prevention after bone marrow transplant. Both patients were obese which may have also contributed to the PTC. Cessation of CsA and combinations of mycophenolate mofetil or tacrolimus and systemic steroids and/or acetazoleamide were effective in managing the symptoms, improving the ocular complications and keeping GvHD asymptomatic. These cases suggest that induction of PTC by CsA used for GvHD prophylaxis in patients undergoing bone marrow transplant is not rare. Physicians who are following patients on CsA need to be alert to the possibility of PTC. Prompt diagnosis followed by thorough evaluation and treatment are crucial for preventing visual loss and improving associated symptoms.
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Affiliation(s)
- Raz Somech
- Divisions of Immunology/Allergy, The Hospital for Sick Children and The University of Toronto, 555 University Avenue, Toronto, Ontario, Canada.
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