Shawn C. Aylward

Pediatric idiopathic intracranial hypertension: a need for clarification.

Risk factors may include: Increase pressure resulting from: Obesity (especially recent Sinus venous thrombosis 0.9 per 100,000,1 idiopathic intracranial hypertension (pseudotumor cerebri) is uncommon even among adults. The prevalence of the condition among children has not been systematically investigated, but it seems to occur far more often among children than once suspected. Diagnostic criteria for idiopathic intracranial hypertension can be difficult to apply to children, sometimes making the evaluation and treatment of childrenwith the disorder difficult.

Intracranial Hypertension Without Papilledema in Children

This study aims to determine the frequency of intracranial hypertension without papilledema in children. Charts of patients evaluated in a pediatric intracranial hypertension clinic at our institution were retrospectively reviewed. The patients were divided into 2 groups depending on whether they had presence or absence of optic nerve edema at the time of presentation. Age, body mass index, and opening cerebrospinal fluid pressures were considered continuous variables and compared by Wilcoxon rank sum test because of non-normality. A P-value of 0.05 was considered significant. A total of 228 charts were reviewed; 152 patients met the criteria for intracranial hypertension, and 27 patients (17.8%) met the criteria of headache without optic nerve edema. There was no clinically significant difference in age, body mass index, opening pressure, and modified opening pressure between the 2 groups.

Diagnostic criteria in pediatric intracranial hypertension

BACKGROUND The modified Dandy criteria and the newer diagnostic criteria for pseudotumor cerebri syndrome (PTCS) are both used to diagnose intracranial hypertension (IH). In comparison to the modified Dandy criteria, the PTCS criteria stratify the IH diagnosis into definite, probable, and suggested categories, exclude clinical symptoms, and use radiologic evidence for diagnosis. There is a lack of consensus on which criteria should be used in the pediatric population. The purpose of this study was to compare the diagnostic criteria for PTCS to the modified Dandy criteria and to identify limitations within both sets of criteria. METHODS The PTCS criteria were retrospectively applied to 50 patients originally diagnosed with IH under the modified Dandy criteria. RESULTS Of the 50 patients, 31 (62%) met diagnostic criteria for definite PTCS, 10 (20%) met criteria for probable PTCS, and 9 patients (18%) failed to meet sufficient PTCS criteria for diagnosis. CONCLUSIONS Although the PTCS criteria use objective data to make the IH diagnosis, we found subjective symptoms to be useful indicators of disease in this group of patients. Additionally, distinguishing probable from definite IH may not have clinical relevance, because both groups were treated similarly. The absence of radiographic evidence of IH should not preclude a diagnosis of the condition, as it was present in a minority of patients included in this study. Further research is needed to clarify the disease process in patients who present with signs and symptoms of elevated intracranial pressure but lack ocular pathology.

Pediatric Intracranial Hypertension

Headaches are common in the clinical setting. Fortunately, intracranial hypertension (IH) is rare, but when present it can lead to significant morbidity. Early diagnosis and proper management are important to lessen the potential morbidity. Careful headache history, ophthalmologic examination, head imaging, and lumbar puncture (LP) are crucial tools in the diagnosis of this condition. Management should be coordinated with a neurologist, ophthalmologist, or neuro-ophthalmologist.

Pediatric Intracranial Hypertension: a Current Literature Review

Purpose of ReviewThe purpose of this review is to provide an update on pediatric intracranial hypertension.Recent FindingsThe annual pediatric incidence is estimated at 0.63 per 100,000 in the USA and 0.71 per 100,000 in Britain. The Idiopathic Intracranial Hypertension Treatment Trial found improvement in visual fields, optical coherence tomography, Frisen grade, and quality of life with acetazolamide compared to placebo in adult patients, and these findings have been translated to the pediatric population.SummaryPediatric intracranial hypertension is a disorder that if left untreated can lead to poor quality of life and morbidity. There are no current treatment studies in pediatrics, but adult data suggests acetazolamide remains an acceptable first-line medication.

General anesthesia with a native airway for patients with mucopolysaccharidosis type III

Mucopolysaccharidosis type III is a progressive disease with worsening airway, pulmonary, and cardiac involvement that may complicate anesthetic care.

Book Review: Brain Safari: Sick Children Sick Brains and Other Maladies

Every doctor encounters interesting patients throughout his or her career that can leave an impression. Often these interesting patients stick with us, influencing the ways in which we assess and treat future patients with similar symptoms. Brain Safari: Sick Children Sick Brains and Other Maladies is a soft cover book meant as a memoir of interesting patients the author saw during his medical career. Some of the more interesting cases were drawn from the period spent either as an intern at Gorgas Hospital in the Panama Canal Zone or establishing a medical training program in the Middle East. There are an additional few that he admittedly never saw but included for historical value. The cases are presented as vignettes followed by supporting information meant to provide either historical or factual background for the reader. The strengths of the book surround the cases presented. There are many cases that a physician practicing in a metropolitan (or even rural) North American city will not encounter with any regularity. Given the tendency for Americans to travel to remote regions on vacation, it is conceivable that one may be lucky enough to encounter a case of malaria or yellow fever in a weary returning traveler. Others are merely for entertainment value, as it is unlikely one would ever encounter a Fer-de-Lance bite in the United States. The main weakness of the book is the organization of the cases presented. The cases do not appear grouped together by a unifying subject matter (genetic, infectious, etc). This leads to repetition of background historical information for the reader. Had the chapters been better grouped, this repetition could have been largely avoided. There were a few factual errors or omissions. For example, in the chapter ‘‘Hand Movements,’’ he states that females only have one X-chromosome and thus why they are affected with Rett syndrome instead of males. He also endorsed some older therapies such as administering Aspirin for fevers or betablockers for migraines in younger patients. Though these are small errors that most practicing practitioners would overlook, it does raise some concerns for laypersons reading this book. Overall, you can tell the author’s love of history and knowledge he gained while writing a biography about Samuel Taylor Darling who worked in Panama during the construction of the Panama Canal. The book does provide good historical perspective of the issues surrounding insectborne illnesses suffered by laborers during the construction of the Panama Canal and methodologies used to root out the causes with available early 20th-century technologies.