Pediatric idiopathic intracranial hypertension and extreme childhood obesity: A comment on visual outcomes

Szewka, Aimee; Newman, Nancy J.; Biousse, Valérie

doi:10.1016/j.jpeds.2012.07.058

Cited by 33 publications

(42 citation statements)

References 6 publications

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“…Most patients had high-grade papilledema, and the authors considered the possibility that a crowded disc with small scleral canals increases the vulnerability of the axons. Szewka et al (16) found a trend toward more severe VL in one or both eyes at last follow-up among patients with BMI > 40. Logistic regression modeling revealed that 10-unit (kg/m 2 ) increases in BMI increased the odds of severe VL by 1.4 times (p=0.03) after controlling for sex, race, diagnosed hypertension, and diagnosed sleep apnea.…”

Section: Discussionmentioning

confidence: 97%

“…Patients were predominantly overweight women (average BMI of 32 kg/cm², Class I obesity) of childbearing age (average, 35 years). This profile has been extensively des cribed in the literature, particularly for patients with IIH (9,11,16,19) . Headache, present in 80% of our patients, was the most prevalent symptom, matching figures reported in other studies (72%-94%) (8,9,11,20,21) .…”

Section: Discussionmentioning

confidence: 99%

“…Because blindness is the most significant complication of PTC, despite great variations in incidence and severity, it is very important to identify factors that directly influence disease outcome. Nevertheless, few authors have attempted such factor identification (8,9,11,16) . In our study, as shown by univarate analysis, TD >6 months, MIP, and hypertension were significantly associated with severe VL.…”

Section: Discussionmentioning

confidence: 99%

“…The occurrence and severity of PTC-related VL are quite variable and very often do not correlate well with other findings of the disease. Few studies have evaluated predictive factors for the occurrence and severity of VL in PTC (8,9,16,17) , making early diagnosis and timely treat ment difficult, despite the importance of minimizing permanent disability. Although VL is frequently permanent in advanced cases of PTC, visual improvement may occur in the early stages, although at an incidence that is not well defined in the literature at present.…”

Section: Introductionmentioning

confidence: 99%

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Factors affecting visual loss and visual recovery in patients with pseudotumor cerebri syndrome

Afonso¹,

Talans²,

Monteiro³

2015

Arquivos Brasileiros De Oftalmologia

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Purpose: To investigate the frequency of visual loss (VL), possible predictive factors of VL, and improvement in patients with pseudotumor cerebri (PTC) syn drome. Methods: We reviewed 50 PTC patients (43 females, seven males) who underwent neuro-ophthalmic examination at the time of diagnosis and after treatment. Demographic data, body mass index (BMI), time from symptom onset to diagnosis (TD), maximum intracranial pressure (MIP), occurrence of cerebral venous thrombosis (CVT), and treatment modalities were reviewed. VL was graded as mild, moderate, or severe on the basis of visual acuity and fields. Predictive factors for VL and improvement were assessed by regression analysis. Results: The mean ± SD age, BMI, and MIP were 35.2 ± 12.7 years, 32.0 ± 7.5 kg/cm², and 41.9 ± 14.5 cmH 2 O, respectively. Visual symptoms and CVT were present in 46 and eight patients, respectively. TD (in months) was <1 in 21, 1-6 in 15, and >6 in 14 patients. Patients received medical treatment with (n=20) or without (n=30) surgery. At presentation, VL was mild in 16, moderate in 12, and severe in 22 patients. Twenty-eight patients improved and five worsened. MIP, TD, and hypertension showed a significant correlation with severe VL. The best predictive factor for severe VL was TD >6 months (p=0.04; odds ratio, 5.18). TD between 1 and 6 months was the only factor significantly associated with visual improvement (p=0.042). Conclusions: VL is common in PTC, and when severe, it is associated with a delay in diagnosis. It is frequently permanent; however, improvement may occur, particularly when diagnosed within 6 months of symptom onset.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Factors affecting visual loss and visual recovery in patients with pseudotumor cerebri syndrome

Afonso¹,

Talans²,

Monteiro³

2015

Arquivos Brasileiros De Oftalmologia

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“…In fact, clear data on this topic are not available as only recently some reports have focused on the evaluation of the possible correlations between some clinical and instrumental aspects in the follow up of IIH patients [8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

Headache prevalence and clinical features in patients with idiopathic intracranial hypertension (IIH)

D’Amico¹,

Curone²,

Ciasca

et al. 2013

Neurol Sci

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Headache is a key symptom of idiopathic intracranial hypertension (IIH). Operational diagnostic criteria for ''Headache attributed to IIH'' are included in the international classification of headache disorders, the ICHD-2. The association of IIH with obesity was established by several reports. We investigate the prevalence of headache and its main clinical features in a clinical sample of IIH patients. The possible correlations between the presence of headache and body mass index (BMI) and intracranial pressure (ICP) levels were studied in a consecutive clinical series of patients, in whom diagnosis of IIH was confirmed by exclusion of secondary forms and by the evidence of increased ICP. Differences for age, BMI, and ICP between patients with and without headache and between males and females were assessed with MannWhitney U test. Spearman's correlation analysis was used to assess relationships between age, BMI, and ICP. P value \ 0.05 was used to set statistical significance. 40 patients entered the study (9 males, 31 females; mean age 39, 8 years, SD 13.2). Headache was reported by 75 % patients. Those characteristics which are included in the present international diagnostic criteria for ''Headache attributed to IIH'' were reported by a remarkable proportion of the studied patients, but not by all. On the other hand, some headache features usually attributed to migraine forms, and which are not among the required criteria were present in some patients: pulsating quality and unilateral distribution of pain in around 20 %, and migrainous associated symptoms in more than 40 % of the sample. According to statistical analyses, no differences were found for age, BMI, and ICP between patients with and without headache. Our results confirmed the strong association between headache and IIH. Although no significant correlations between some of the key features of IIH were found in this study, we suggest that further studies on larger series-possibly with a longitudinal evaluation-are needed, to help clinicians in categorizing different subgroups among IIH patients as well as in identifying the main factors influencing the prognosis of this disorder.

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Enlargement of Meckel's cave in patients with spontaneous cerebrospinal fluid leaks

Aaron

Illing

Lambertsen

et al. 2016

Int Forum Allergy Rhinol

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Pediatric idiopathic intracranial hypertension and extreme childhood obesity: A comment on visual outcomes

Cited by 33 publications

References 6 publications

Factors affecting visual loss and visual recovery in patients with pseudotumor cerebri syndrome

Factors affecting visual loss and visual recovery in patients with pseudotumor cerebri syndrome

Headache prevalence and clinical features in patients with idiopathic intracranial hypertension (IIH)

Enlargement of Meckel's cave in patients with spontaneous cerebrospinal fluid leaks

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