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Dr. Jacob Genizi Dr Eli Shahar Child Neurology Unit Meyer Children Hospital,

Meta-Analysis of Pseudotumor Cerebri in Prepubertal Children Vs adolescents: Differences in Sex Distribution and Obesity Rate. Dr. Jacob Genizi Dr Eli Shahar Child Neurology Unit Meyer Children Hospital, Rambam Medical Center, Haifa, Israel.

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Dr. Jacob Genizi Dr Eli Shahar Child Neurology Unit Meyer Children Hospital,

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  1. Meta-Analysis of Pseudotumor Cerebri in Prepubertal Children Vs adolescents: Differences in Sex Distribution and Obesity Rate Dr. Jacob Genizi Dr Eli Shahar Child Neurology Unit Meyer Children Hospital, Rambam Medical Center, Haifa, Israel.

  2. Modified Dandy’s Criteria for the diagnosis of Idiopathic Intracranial Hypertension • Signs and symptoms of increased intracranial hypertension • No localizing neurological sign other than papilledema or abducens nerve palsy. • Normal neuroimaging studies other than empty sella. • Documented increased intracranial pressure (200 mm of water and higher) with normal fluid contens. • Exclusion of structural or systemic cause. Smith JL. Whence pseudotumor cerebri? Clin Neuroophthalmol. 1985 Mar;5(1):55-6.

  3. Pseudotumor Cerebri Idiopathic Intracranial Hypertension

  4. Etiology (PTC) Metabolic and endocrine disorders: • Hypoparathyroidism. • Hypothyroidism. • vitamin D deficiency. • Addison, Congenital adrenal hyperplasia. • Menarche. • Treatment or cessation of corticosteroids.

  5. Etiology (PTC) • Otitis media. • Mastoiditis. • Sinus vein thrombosis. Hematologic disturbances: • Iron deficiency Anemia. • Hemolysis. • Polycytemia.

  6. Etiology (PTC) Medication • Nalidixic acid • Ciprofloxacin • Tetracycline, minocycline • Vitamin A. • GH therapy. • Thyroid replacement therapy.

  7. Etiology (IIH) Miscellaneous or Risk Factors ??? • Women of reproductive age. • Obesity.

  8. ADULTSVS CHILDREN

  9. הבדלים עיקריים בין ילדים לבין מבוגרים מבוגרים ילדים ותינוקות מגדר נשים בד”כ בנים = בנות השמנת יתר "גורם סיכון" חשוב לא מהווה גורם סיכון פי 10-20 משמעותי ביטוי קליני כאבי ראש אי-שקט, אפטיה, ישנוניות חולשה של C.N. 6, פזילה, חולשה של C.N. 7, כאבי גב וצואר, כאבי ראש. Papilledemaכן כשמרפסים או סוטורות קרניאליות פתוחים, בד”כ אין פפילאדמה.

  10. META – ANALYSIS PTC – Children (Scott 1997)

  11. Prepubertal childrenVSAdolescence

  12. Our Data of PTC: 1995-2005

  13. LITERATURE REVIEW OF PTC IN CHILDREN

  14. META – ANALYSIS:

  15. Pathophysiology • Adults - Sex hormones and lipids' regulation in the female may play a role in the induction of PTC. • Children - Disordered CSF dynamics.

  16. Symptoms at presentationAdults • Headache (90%) • Nausea & vomiting (56%) • Double vision (38%) • Visual loss/ blurred vision (25%) • Sore / stiff neck (9%) • Change in personality (9%) • Lethargy / anorexia (6%) • Dizziness (6%) • Painful eyes

  17. Symptoms at presentation- Children • Incidental – Asymptomatic. • Ataxia • Photophobia • Myalgia • Tinnitus • Limb numbness

  18. Symptoms at presentation- Infants • Irritability • Apathy • Somnolence • Increasing head size

  19. Treatment • Acetazolamide (Diamox) • Cortico-steroids • Lumboperitoneal (LP) shunting • Optic nerve sheath fenestration

  20. Conclusions: • Pseudotumor cerebri among prepubertal children bares different characteristics compared with adolescents: • Boys affected more frequently than girls. • Concurrent obesity is significantly less common in pre-pubertal children.

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