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Dr. Jacob Genizi Dr Eli Shahar Child Neurology Unit Meyer Children Hospital, Rambam Medical Center, Haifa, Israel. PowerPoint PPT Presentation


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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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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.


ADULTSVS CHILDREN


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)


Prepubertal childrenVSAdolescence


Our Data of PTC: 1995-2005


LITERATURE REVIEW OF

PTC IN CHILDREN


META – ANALYSIS:


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.


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