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Sensitivity of Papilledema as a Sign of Increased Intracranial Pressure
David Krahulik1, Lumir Hrabalek1, Filip Blazek1
1Department of Neurosurgery, University Hospital Olomouc, 779 00 Olomouc, Czech Republic.
Insights
Papilledema is a less sensitive indicator of increased intracranial pressure (ICP) in children than previously thought. Its absence does not rule out high ICP, particularly in younger children.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Neurocritical Care
Background:
- Increased intracranial pressure (ICP) is a critical condition in children.
- Papilledema, optic disc swelling, is a potential sign of elevated ICP.
- The diagnostic sensitivity of papilledema in pediatric ICP cases requires further evaluation.
Purpose of the Study:
- To assess the sensitivity of papilledema as an indicator of increased ICP in pediatric patients.
- To identify factors associated with papilledema in children with elevated ICP.
Main Methods:
- Retrospective review of pediatric patients (<18 years) diagnosed with increased ICP.
- Analysis of dilated fundus examinations conducted between 2019 and 2021.
- Evaluation of patient age, sex, etiology, symptom duration, ICP levels, and papilledema presence.
Main Results:
- Out of 39 patients, only 20% (8 patients) presented with papilledema.
- Papilledema was significantly more prevalent in older children (mean age 10.4 years) compared to those without (mean age 5.7 years).
- No significant associations were found between papilledema and sex, diagnosis, or symptom duration.
Conclusions:
- The low incidence of papilledema (20%) suggests it is not a highly sensitive marker for increased ICP in children.
- The absence of papilledema should not exclude the possibility of elevated ICP, especially in younger pediatric populations.
- Clinical vigilance for increased ICP is crucial in children, irrespective of funduscopic findings.
Abstract:
Our study evaluates the sensitivity of papilledema as a sign of high intracranial pressure in children. Patients younger than 18 years old, diagnosed with increased ICP, and who had received dilated fundus examination between 2019 and 2021 were retrospectively reviewed. Factors including the patient's age, sex, aetiology, duration of signs or symptoms, intracranial pressure (ICP), and presence of papilledema were evaluated. We included 39 patients in this study, whose mean age was 6.7 years. The 31 patients without papilledema had a mean age of 5.7 years, and 8 patients (20%) with papilledema had a mean age of 10.4 (p < 0.037). The mean duration of signs or symptoms was nine weeks in patients without papilledema and seven weeks in those with papilledema (p = 0.410). The leading causes of increased ICP with papilledema were supratentorial tumor (12.5%), infratentorial tumor (33.3%), and hydrocephalus (20%) (p = 0.479). Papilledema was statistically significantly more common in older patients. We found no statistical significance between sex, diagnosis, and symptoms. The relatively low incidence of papilledema (20%) in our study shows that papilledema's absence does not ensure the absence of increased ICP, especially in younger patients.
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Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.