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Demographics, clinical features, and response to conventional treatments in pediatric Pseudotumor Cerebri syndrome: a single-center experience

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Abstract

Objective

The goal of this study was to better understand pediatric Pseudotumor Cerebri syndrome, and its relationship to age, obesity, and other medical conditions; and to evaluate response to conventional treatments.

Methods

A retrospective chart review was performed on consecutive patients who were diagnosed with PTCS between January 1, 2007, and July 31, 2014. A total of 78 patients were included in this study: 54 female (69.3%) and 24 male (30.7%). Variables including age, sex, body mass index, concomitant medical conditions, secondary causes, associated symptoms, physical exam findings, imaging results, recurrence of symptoms, and treatment modalities were analyzed. Patients were grouped into “pre-kindergarten,” “elementary,” and “adolescent” based on their age; and weight categories of underweight, normal weight, overweight, moderately, and severely obese.

Results

Mean age of symptom onset was 11.92 ± 4.09 years. Elementary and adolescent age patients were more likely to be overweight, moderately obese, and severely obese, while this finding was not found for patients in pre-kindergarten group. Headache (83.3%) and visual disturbances (48.7%) were the most common presenting complaints. Asthma (16.6%) was the most common associated concomitant medical condition. Medical management resulted in resolution in 84% of population, 15% required surgical interventions, and the recurrence rate was found to be 20.5%. There was a statistically significant trend in success with medical management in younger patients (p = 0.04), while medically refractory PTCS was seen in adolescent females. Recurrence of PTCS had a linear trend with increased occurrence in adolescent age group with higher BMI. Asthma was observed to be frequently associated with PTCS in our cohort. Obesity is strongly associated with PTCS, not only in the adolescent group but also in the younger elementary age group. Treatment remains similar to management in the adults with a good response (84%) to medical management and a low relapse rate.

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Abbreviations

IIH:

Idiopathic intracranial hypertension

PTCS:

Pseudotumor Cerebri syndrome

ICP:

Intracranial pressure

CSF:

Cerebrospinal fluid

BMI:

Body mass index

MRI:

Magnetic resonance imaging

MRV:

Magnetic resonance venography

LPS:

Lumboperitoneal shunt

VPS:

Ventriculoperitoneal shunt

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Acknowledgements

Statistical support for this research was underwritten by the University of Louisville Office of Graduate Medical Education.

Funding

No financial supports were used to perform this study.

Author information

Authors and Affiliations

  1. Division of Child Neurology, Department of Neurology, Columbia University Medical Center, New York, NY, USA

    Sonam Bhalla

  2. Department of Pediatrics, Johns Hopkins All Children’s Hospital, St. Petersburg, FL, USA

    Noura Estephane Nickel

  3. Division of Pediatric Neurosurgery, Norton Neuroscience Institute, Norton Children’s Hospital and University of Louisville School of Medicine, Louisville, KY, USA

    Ian Mutchnick

  4. University of Louisville Office of Graduate Medical Education, Louisville, KY, USA

    Craig Ziegler

  5. Division of Child Neurology, Department of Neurology, University of Louisville School of Medicine, Louisville, KY, USA

    Michael Sowell

Authors
  1. Sonam Bhalla
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  2. Noura Estephane Nickel
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  3. Ian Mutchnick
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  4. Craig Ziegler
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  5. Michael Sowell
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Correspondence to Sonam Bhalla.

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Bhalla, S., Nickel, N.E., Mutchnick, I. et al. Demographics, clinical features, and response to conventional treatments in pediatric Pseudotumor Cerebri syndrome: a single-center experience. Childs Nerv Syst 35, 991–998 (2019). https://doi.org/10.1007/s00381-019-04150-y

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  • DOI: https://doi.org/10.1007/s00381-019-04150-y

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