Pseudotumor cerebri in pediatric age: role of obesity in the management of neurological impairments

Abstract

Pseudotumor cerebri occurs quite rarely in the pediatric population and its clinical features differ from adults in many ways. Intracranial hypertension with papilledema should obviously be treated promptly to avoid permanent visual damage, but various more or less invasive options have been proposed over the years, from bariatric surgery for obesity to optic nerve sheath fenestration. We report a prospective study on a group of 15 children, aged 3-16 years, with clinical and instrumental diagnosis of pseudotumor cerebri. All the patients were treated simply by external lumbar cerebrospinal fluid drainage with a mean volume of 10 ml/h for 3-5 days, with hypocaloric diet and with appropriate dosages of acetazolamide. All had immediate relief of headache, a considerable reduction in papilledema and marked improvement of both visual loss and cranial nerve palsies within 2 months. None of the patients relapsed during the follow-up period, ranging from 12-48 months.

ASMBS pediatric metabolic and bariatric surgery guidelines, 2018

“…Response to all therapies is variable. Ventricular/lumbar peritoneal shunts have been used to lower intracranial pressure, preserve vision, and relieve other symptoms [71,72]. There are published case reports of success with weight loss after RYGB [73–75].…”

Osteoblastoma mimicking an idiopathic intracranial hypertension syndrome

“…[13] A cerebral angiography was performed to assess the extent of sinus obstruction, as in our case the MRI-angiogram proved to be of low accuracy to such purpose.…”

Metabolic, behavioral health, and disordered eating comorbidities associated with obesity in pediatric patients: An Obesity Medical Association (OMA) Clinical Practice Statement 2022

“…IIH affects more female patients than male patients: primary IIH patients are 72.5% female, and secondary IIH patients are 75.8% female [ 7 , 7 , 8 ]. However, this sex difference changes based on pubertal status; the pre-pubertal female-to-male ratio is 1:1.04, while the post-pubertal female-to-male ratio is 6:1 [ 9 , 10 ]. In addition, higher body mass indexes (BMIs) are noted in post-pubertal patients with primary IIH [ 7 , 8 , 11 , 12 ].…”

“…There is a strong association between childhood obesity and increased risk of pediatric IIH. The incidence of IIH in youth with obesity is lower in prepubertal children than in adolescents [ 9 , 10 ].…”

“…Loss of as little as 6% of body weight has been noted to reduce intracranial pressure [ 18 ]. Pharmacotherapy treatments may include acetazolamide, headache management (which can include topiramate), serial lumbar punctures, and lumbo-peritoneal shunts if needed [ [7] , [8] , [9] ].…”