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The role of clinical signs in the diagnosis of papilledema: development of an algorithm

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Abstract

Purpose

The aim of this study was not only to emphasize the role of clinical signs as well as ophthalmologic evaluation for accurate and differential diagnosis of papilledema (PE), but also to present an instructive algorithm that would help to eliminate unnecessary examinations and treatments.

Method

The files of 43 patients (ages 0–18) diagnosed with PE were retrospectively reviewed. The study included 25 patients from our pediatric neurology outpatient clinic, who were thought to have PE, and 18 patients, who were referred from the external centers to our hospital with a pre-diagnosis of PE.

Results

Of the 43 patients, 28 had PE, 8 had pseudopapilledema (PPE), and 7 had optic nerve pathologies (ONP). For patients who applied directly to our pediatric neurology unit, a margin of error of 8% was detected based on only a simple ophthalmologic examination and an evaluation of clinical findings. For the patients who were forwarded to our pediatric neurology unit from the external centers without examining any clinical findings and with no details, the margin of error was 72%.

Conclusion

For patients with suspected PE, advanced ophthalmologic opinion is a necessary requirement before invasive radiological examinations are used. When the ophthalmologic evaluation is properly elaborated, the distinction can be made more clearly by using noninvasive methods. In order to determine the gold standard in terms of the methods used in the evaluation of patients who are not clinically diagnosed, new prospective studies with more patients should be planned.

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Availability of data and material

The data and the materials described in this study, including all relevant raw data, will be freely available from the corresponding author on reasonable request, without breaching participant confidentiality.

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Acknowledgments

We would like to express our special thanks to Pediatrics Department of Bolu Abant İzzet Baysal University, especially their lecturers and assistant doctors, for helping us throughout all stages of this work.

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Authors and Affiliations

  1. Department of Pediatric Neurology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey

    Sevim Türay, Nimet Kabakuş & Fatma Hancı

  2. Department of Ophthalmology, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey

    Fatih Ulaş

  3. Department of Pediatrics, Faculty of Medicine, Abant Izzet Baysal University, Bolu, Turkey

    Mustafa Dilek & Büşra Cihan

Authors
  1. Sevim Türay
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  2. Nimet Kabakuş
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  3. Fatma Hancı
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  4. Fatih Ulaş
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  6. Büşra Cihan
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Contributions

We, all and each one of the authors, certify that we have participated sufficiently in the intellectual content, conception, and design of this work or the analysis and interpretation of the data, as well as the writing of the manuscript, to take public responsibility for it and have agreed to have our name listed as a contributor. We believe the manuscript represents valid work. Each author confirms they meet the criteria for authorship as established by the ICMJE. All persons who have made substantial contributions to the work reported in the manuscript, but who are not contributors, are named in the Acknowledgment. If we do not include an Acknowledgment that means we have not received substantial contributions from non-contributors and no contributor has been omitted.

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Correspondence to Sevim Türay.

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Conflict of interest

The authors declare that they have no conflict of interest and this publication was prepared without any external sources of funding.

Ethics approval

Approval for the study was granted by the Abant İzzet Baysal University Ethical Committee (No. 2020/137) which shows that the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Consent to participate and publish

A freely-given, informed consent to participate in the study was obtained from all patients (or their parents or legal guardians) mentioned in this study. The authors also affirm that all participants provided informed consent for publication of their data in a journal article.

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Türay, S., Kabakuş, N., Hancı, F. et al. The role of clinical signs in the diagnosis of papilledema: development of an algorithm. Childs Nerv Syst 37, 599–605 (2021). https://doi.org/10.1007/s00381-020-04869-z

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  • DOI: https://doi.org/10.1007/s00381-020-04869-z

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