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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.


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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.


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Pseudotumor Cerebri

Idiopathic Intracranial Hypertension


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Etiology (PTC)

Metabolic and endocrine disorders:

  • Hypoparathyroidism.

  • Hypothyroidism.

  • vitamin D deficiency.

  • Addison, Congenital adrenal hyperplasia.

  • Menarche.

  • Treatment or cessation of corticosteroids.


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Etiology (PTC)

  • Otitis media.

  • Mastoiditis.

  • Sinus vein thrombosis.

    Hematologic disturbances:

  • Iron deficiency Anemia.

  • Hemolysis.

  • Polycytemia.


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Etiology (PTC)

Medication

  • Nalidixic acid

  • Ciprofloxacin

  • Tetracycline, minocycline

  • Vitamin A.

  • GH therapy.

  • Thyroid replacement therapy.


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Etiology (IIH)

Miscellaneous or Risk Factors ???

  • Women of reproductive age.

  • Obesity.


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ADULTSVS CHILDREN


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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.


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META – ANALYSIS

PTC – Children (Scott 1997)


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Prepubertal childrenVSAdolescence


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Our Data of PTC: 1995-2005


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LITERATURE REVIEW OF

PTC IN CHILDREN


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META – ANALYSIS:


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Pathophysiology

  • Adults - Sex hormones and lipids' regulation in the female may play a role in the induction of PTC.

  • Children - Disordered CSF dynamics.


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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


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Symptoms at presentation- Children

  • Incidental – Asymptomatic.

  • Ataxia

  • Photophobia

  • Myalgia

  • Tinnitus

  • Limb numbness


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Symptoms at presentation- Infants

  • Irritability

  • Apathy

  • Somnolence

  • Increasing head size


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Treatment

  • Acetazolamide (Diamox)

  • Cortico-steroids

  • Lumboperitoneal (LP) shunting

  • Optic nerve sheath fenestration


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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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