Presumed Pseudotumor Cerebri Syndrome After Withdrawal of Inhaled Glucocorticoids

Kwon, Young Joon; Allen, Julian L.; Liu, Grant T.; McCormack, Shana E.

doi:10.1542/peds.2015-2091

Cited by 12 publications

(7 citation statements)

References 16 publications

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“…3,26 Short courses of steroids can be used as a bridge to the treatment of pseudotumor cerebri syndrome in fulminant disease, likely acting to reduce papilledema. However, this clinical scenario as well as previous reports of pseudotumor cerebri onset following withdrawal of systemic and inhaled steroids 27 -29 suggests that lack of steroids might inversely promote pseudotumor cerebri. Thus, steroids may play a more central role to pseudotumor cerebri syndrome pathophysiology than previously believed.…”

Section: Discussionmentioning

confidence: 62%

Assessment of Pediatric Pseudotumor Cerebri Clinical Characteristics and Outcomes

et al. 2020

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Pseudotumor cerebri also known as idiopathic intracranial hypertension is a relatively uncommon disorder of unknown pathophysiology. Although pseudotumor cerebri occurs in both children and adults, the pseudotumor cerebri literature is heavily dominated by adult studies. The aim of this study is to retrospectively describe the clinical presentation, imaging, treatment, and outcomes of a large pediatric pseudotumor cerebri population over a 23-year period. We also discuss secondary pseudotumor cerebri (44%) as well as the increasingly recognized patient subgroups without headache (13.3%) and without papilledema (7.3%). Female sex, obesity, and initial symptoms were consistent with the literature; however radiographic findings were surprisingly low in this cohort. Headache outcomes at 1 week, 1 month, and 3 months following initial lumbar puncture/treatment and visual function outcomes are reported.

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Section: Discussionmentioning

confidence: 62%

Assessment of Pediatric Pseudotumor Cerebri Clinical Characteristics and Outcomes

et al. 2020

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“…We found that prophylactic dexamethasone was able to prevent IIH symptoms that would otherwise consistently appear in the infant patient following HD-MTX. This is a surprising finding when compared to previous research that showed corticosteroids used for treatment of autoimmune diseases like JIA and Crohn's disease could cause IIH after prolonged use in children and adults (Friedman et al, 2014;Kwon et al, 2016). There is a paucity of pediatric data to guide the use of medications in IIH, so there is much debate surrounding treatment of IIH in children.…”

Section: Discussionmentioning

confidence: 76%

High-Dose Methotrexate-Induced Idiopathic Intracranial Hypertension in Infant Acute Lymphoblastic Leukemia

et al. 2020

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A 7-month-old baby girl with acute lymphoblastic leukemia (ALL) presented with bulging anterior fontanelle after completing the first and second courses of high-dose methotrexate (HD-MTX) chemotherapy. Between courses, the infant recovered and was discharged. Prior to the third and fourth HD-MTX courses, the baby girl was administered infusions of dexamethasone, which prevented recurrence of neurological side effects observed after the first and second courses of HD-MTX. To our knowledge, this is the first reported case of HD-MTX-induced idiopathic intracranial hypertension in infants, and that prophylactic use of dexamethasone can be applied to prevent acute intracranial hypertension following HD-MTX infusion.

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“…[ 11 29 ] Similarly, steroids administration was reported by a small portion of our study participants. Although the evidence does not support the presence of a correlation between steroids use and IIH,[ 30 ] previous studies reported that steroids withdrawal is significantly correlated,[ 31 ] which can be explained by the induced adrenocortical insufficiency. [ 32 ]…”

Section: Discussionmentioning

confidence: 97%

Visual outcomes of idiopathic intracranial hypertension in a neuro-ophthalmology clinic in Jeddah, Saudi Arabia

Mandura

Khawjah

Alharbi

et al. 2023

Saudi Journal of Ophthalmology

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PURPOSE: Idiopathic intracranial hypertension (IIH) is a disorder with elevated intracranial pressure more than 250 mm H2O, without evidence of meningeal inflammation, space-occupying lesion, or venous thrombosis. In this study, we aim to study the clinical profile, evaluation, management, and visual outcome in a hospital-based population of IIH cases in Jeddah. METHODS: This is a retrospective observational cohort study that included the medical records of all patients referred to neuro-ophthalmology service for evaluation of papilledema. The medical records have been reviewed from October 2018 to February 2020 at Jeddah Eye Hospital, Saudi Arabia. A total of 51 patients presented with papilledema in the studied period. Forty-seven patients met our inclusion criteria and were included in the study. RESULTS: The study found that the incidence rate of IIH is 16:100 of the referred cases to the neuro-ophthalmology clinic. Most of the patients were females (41, 91.2%), with a mean age of presentation of 32 ± 11 years. The most common presenting symptom was headache (40 patients, 88.8%), followed by transient visual obscuration (TVO) (20 patients, 44.4%), and reduced visual acuity (15 patients, 33.3%). All 45 patients were started on medical treatment with oral acetazolamide with four patients (8.8%) shifted to topiramate because of the lack of response or intolerance to acetazolamide while four patients (8.8%) underwent lumbar-peritoneal shunt because of inadequate control of the disease despite the treatment with medical therapy. For both eyes, the change in visual acuity across all assessment points was statistically significant. Nevertheless, there were no significant changes in the visual field findings among all of the compared assessment points. CONCLUSION: The present study has shown that IIH-related papilledema is common in young female patients with headaches, TVOs, and reduced visual acuity. Those are the most common symptoms in our IIH population. Medical treatment and monitoring of IIH is efficient and should be considered to enhance the prognosis of IIH-related complications. In addition, the visual acuity and the visual field should be frequently monitored for these patients.

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Presumed Pseudotumor Cerebri Syndrome After Withdrawal of Inhaled Glucocorticoids

Cited by 12 publications

References 16 publications

Assessment of Pediatric Pseudotumor Cerebri Clinical Characteristics and Outcomes

Assessment of Pediatric Pseudotumor Cerebri Clinical Characteristics and Outcomes

High-Dose Methotrexate-Induced Idiopathic Intracranial Hypertension in Infant Acute Lymphoblastic Leukemia

Visual outcomes of idiopathic intracranial hypertension in a neuro-ophthalmology clinic in Jeddah, Saudi Arabia

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