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Papilledema in children with hydrocephalus: incidence and associated factors
Haeng Jin Lee1, Ji Hoon Phi2, Seung-Ki Kim2
1Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Insights
Papilledema is more common in older children with hydrocephalus and higher intracranial pressure (ICP), particularly when caused by a brain tumor. However, its absence doesn't rule out hydrocephalus, especially in younger patients.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Neurosurgery
Background:
- Hydrocephalus is a condition characterized by excess cerebrospinal fluid in the brain.
- Papilledema, or swelling of the optic disc, can be a sign of increased intracranial pressure (ICP).
- The relationship between hydrocephalus and papilledema in pediatric patients requires further investigation.
Purpose of the Study:
- To determine the incidence of papilledema in children diagnosed with hydrocephalus.
- To identify factors associated with the presence of papilledema in this pediatric population.
Main Methods:
- Retrospective review of pediatric patients (<15 years) treated for hydrocephalus between 2005-2015.
- Evaluation of factors including age, sex, hydrocephalus etiology, symptom duration, ICP, and papilledema presence.
- Comparison of characteristics between patients with and without papilledema.
Main Results:
- Papilledema was observed in patients with hydrocephalus who were significantly older (mean age 8.8 vs. 2.7 years) and had higher ICP (mean 33.3 vs. 19.9 cm H2O).
- Brain tumors were the most common cause of hydrocephalus (59%) associated with papilledema.
- The duration of signs or symptoms did not significantly differ between groups with and without papilledema.
Conclusions:
- Older age, higher ICP, and hydrocephalus secondary to brain tumors are associated with a higher incidence of papilledema in children.
- The absence of papilledema in 41% of pediatric hydrocephalus cases highlights that it is not a universally present sign.
- Clinicians should not rely solely on the absence of papilledema to exclude hydrocephalus, particularly in younger children.
Abstract:
OBJECTIVE The aim of this study was to report the incidence of and the factors associated with papilledema in children with hydrocephalus. METHODS Patients younger than 15 years of age who had been diagnosed with hydrocephalus and treated by extra-ventricular drainage or ventriculoperitoneal shunt surgery between 2005 and 2015 were retrospectively reviewed. Factors including patient age and sex, etiology of hydrocephalus, duration of signs or symptoms, intracranial pressure (ICP), and presence of papilledema were evaluated. RESULTS Forty-six patients, whose mean age was 6.3 ± 4.7 years, were included in the study. The 19 patients without papilledema had a mean age of 2.7 ± 2.7 years, and the 27 patients with papilledema had a mean age of 8.8 ± 4.2 years (p < 0.001). The mean ICP was 19.9 ± 10.0 cm H2O among those without papilledema and 33.3 ± 9.1 cm H2O among those with papilledema (p < 0.001). The mean duration of signs or symptoms was 3.0 ± 4.6 months in the patients without papilledema and 3.4 ± 3.9 months in those with papilledema (p = 0.704). The patients with papilledema were older and presented with higher ICP than those without. The causes of hydrocephalus were tumor (59%), congenital anomaly (19%), hemorrhage (13%), and infection (9%). CONCLUSIONS Papilledema was more common in patients who were older, who had higher ICP, and whose hydrocephalus had been induced by brain tumor. However, since papilledema was absent in 41% of the children with hydrocephalus, papilledema's absence does not ensure the absence of hydrocephalus, especially in younger patients.