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Pseudotumor cerebri in a pre-pubescent child--case report
1The Eye Institute, Pennsylvania College of Optometry, Philadelphia, Pennsylvania, USA. doctorlangford@cox.net
Insights
Pseudotumor cerebri (PTC) is rare in children and presents differently than in adults. Pediatric PTC often involves broader neurological deficits and a stronger link to other illnesses.
Area of Science:
- Ophthalmology
- Neurology
- Pediatrics
Background:
- Pseudotumor cerebri (PTC) is a condition of elevated intracranial pressure with unknown cause.
- PTC predominantly affects obese women of childbearing age, but can occur in children with distinct characteristics.
Observation:
- A 10-year-old boy presented with intermittent horizontal diplopia and severe headaches upon waking.
- Ocular examination revealed normal visual acuity, pupil function, and color vision, but optic disk swelling (OU) and intermittent esotropia.
Findings:
- Pediatric PTC is rare and differs from adult presentations.
- Unlike adults, pediatric PTC lacks a clear sexual predilection and shows a stronger association with comorbidities and medications.
- Neurological deficits in children with PTC are often more extensive than in adults.
Implications:
- Children with optic disk swelling require thorough diagnostic evaluation for PTC.
- Understanding the unique features of pediatric PTC is crucial for accurate diagnosis and management.
- Differentiating pediatric PTC from other neuropathologies is essential to avoid diagnostic delays.
Background:
Pseudotumor cerebri (PT) is a disease characterized by elevated intracranial pressure with no apparent etiology. A majority of cases of PTC occur in adults, with a distinct predilection for obese women of childbearing age. On rare occasions, PTC will affect children and is associated with different patient characteristics.
Case Report:
A slender 10-year-old boy was brought to clinic with a one-day history of intermittent horizontal diplopia and a two-week history of severe headaches on awakening. Visual acuity, pupil function, and color vision were all normal. Cover test revealed an intermittent esotropia at distance, with full ocular motilities. Fundus examination revealed swelling of the optic disks OU. Further diagnostic testing, treatment, and followup are discussed.
Conclusions:
Pseudotumor cerebri in children is rare. When present, PTC in children often manifests different characteristics than adults. First, no clear sexual predilection exists for PTC in children. Second, the role of associated illnesses and medications is stronger in children than in adults. Third, the extent of neurologic deficit present in children with PTC is broader than in adults. All children with swollen optic disks warrant a thorough diagnostic evaluation. In the absence of obvious neuropathology, knowledge of the differences between adult and pediatric PTC can help avoid a diagnostic dilemma.
