Acute strabismus in neurological emergencies of childhood: A retrospective, single-centre study
Giacomo Garone1, Valentina Ferro2, Marta Barbato3
1University Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy.
Insights
Acute strabismus in children can indicate serious neurological emergencies, with nearly a quarter of cases linked to conditions like brain tumors. Red flag symptoms such as ptosis and vomiting warrant immediate investigation.
Area of Science:
- Pediatric Ophthalmology
- Pediatric Neurology
- Emergency Medicine
Background:
- Acute strabismus (AS) is a common ocular motility disorder in children.
- Emergency department (ED) evaluations for AS prioritize ruling out dangerous underlying conditions requiring urgent intervention.
Purpose of the Study:
- To describe the epidemiology, clinical features, and causes of AS in pediatric ED patients.
- To identify clinical features predicting a higher risk of neurological emergencies (NEs) in children with AS.
Main Methods:
- Retrospective review of clinical records for patients under 18 with AS over 10 years.
- Logistic regression analysis to identify predictive variables for NEs.
Main Results:
- 208 pediatric patients with AS were identified (0.35 cases per 1000 admissions).
- Neurological emergencies accounted for 24.03% of cases, with brain tumors being the most frequent (8.65%).
- Symptoms like ptosis, optic disk blurring, vomiting, gait abnormalities, and consciousness disorders significantly increased the risk of NEs.
Conclusions:
- Nearly one in four children with AS presenting to the ED may have a serious underlying neurological condition.
- Brain malignancies are a primary dangerous cause of AS in this population.
- Key red flag symptoms include ptosis, papilledema, vomiting, gait disturbances, altered consciousness, pupillary defects, and multiple cranial nerve palsies.
Objectives:
Acute strabismus (AS) is the most common ocular motility disorder in children. In the emergency setting evaluation, the primary concern is to exclude a potentially dangerous underlying condition, requiring immediate intervention. Our first aim was to describe the epidemiology, clinical features, and underlying causes of AS in a cohort of children presenting to the emergency department (ED). Our second aim was to identify clinical features associated with a significant risk of underlying neurological emergencies (NEs).
Design And Setting:
Clinical records of all patients under 18 years presenting for AS to the ED of the Bambino Gesù Children's Hospital over a 10-year period were retrospectively reviewed. A logistic regression model was applied to detect predictive variables associated with a higher risk of NEs.
Results:
208 patients (M:F = 1.19) were identified (0.35 cases per 1000 admission). Commonly associated symptoms included diplopia (18.3%), headache (23.1%), nausea or vomit (8.6%). Other ocular or neurological abnormalities were associated in 47.6% of patients. NEs accounted for 24.03% of all cases, mostly represented by brain tumours (8.65%). Ptosis, optic disk blurring, vomit, gait abnormalities and consciousness disorders were found to confer a significantly greater risk of an underlying NE.
Conclusions:
Potentially severe neurological conditions may affect almost one in four children presenting to the ED for AS. Brain malignancies are the most common dangerous cause. Presence of ptosis, papilledema, vomit, gait disorders, consciousness impairment, pupillary defects and multiple cranial nerves involvement should be considered as red flags.
