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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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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.
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.
Pseudotumor Cerebri Idiopathic Intracranial Hypertension
Etiology (PTC) Metabolic and endocrine disorders: • Hypoparathyroidism. • Hypothyroidism. • vitamin D deficiency. • Addison, Congenital adrenal hyperplasia. • Menarche. • Treatment or cessation of corticosteroids.
Etiology (PTC) • Otitis media. • Mastoiditis. • Sinus vein thrombosis. Hematologic disturbances: • Iron deficiency Anemia. • Hemolysis. • Polycytemia.
Etiology (PTC) Medication • Nalidixic acid • Ciprofloxacin • Tetracycline, minocycline • Vitamin A. • GH therapy. • Thyroid replacement therapy.
Etiology (IIH) Miscellaneous or Risk Factors ??? • Women of reproductive age. • Obesity.
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.
META – ANALYSIS PTC – Children (Scott 1997)
LITERATURE REVIEW OF PTC IN CHILDREN
Pathophysiology • Adults - Sex hormones and lipids' regulation in the female may play a role in the induction of PTC. • Children - Disordered CSF dynamics.
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
Symptoms at presentation- Children • Incidental – Asymptomatic. • Ataxia • Photophobia • Myalgia • Tinnitus • Limb numbness
Symptoms at presentation- Infants • Irritability • Apathy • Somnolence • Increasing head size
Treatment • Acetazolamide (Diamox) • Cortico-steroids • Lumboperitoneal (LP) shunting • Optic nerve sheath fenestration
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.