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Etiologies underlying pediatric papilledema at a tertiary care children's hospital
Andrew F Fischer1, George Muntean1, Valérie Biousse2
1Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.
Insights
Pediatric papilledema, often caused by idiopathic intracranial hypertension (IIH), requires urgent evaluation. Nearly half of cases stem from secondary causes with serious vision and life-threatening implications.
Area of Science:
- Ophthalmology
- Pediatrics
- Neurology
Background:
- Pediatric papilledema is a frequent reason for ophthalmology consultations in emergency and inpatient settings.
- This condition involves optic disc swelling due to increased intracranial pressure.
- It necessitates prompt and thorough evaluation to identify underlying causes.
Purpose of the Study:
- To determine the frequency of pediatric papilledema consultations.
- To identify the diagnoses causing papilledema in children.
- To describe the clinical characteristics of pediatric papilledema presentations.
Main Methods:
- Retrospective review of patients diagnosed with papilledema at a children's hospital (Jan 2021 - Aug 2023).
- Inclusion criteria: patients with papilledema (disk edema from elevated intracranial pressure).
- Data collected: clinical characteristics, underlying diagnoses, and age stratification.
Main Results:
- 71 pediatric patients with papilledema were identified (mean age 13 years; 68% female).
- Papilledema occurred in 3.7% of unique patient consultations.
- Idiopathic intracranial hypertension (IIH) caused 51% of cases; 49% were due to secondary causes with significant risks.
Conclusions:
- Pediatric papilledema is linked to serious underlying conditions.
- A multidisciplinary emergency evaluation is crucial for affected children.
- Early diagnosis and management are vital for preventing vision loss and other complications.
Background:
Pediatric papilledema is a common reason for ophthalmology evaluation in high acuity emergency department and inpatient settings. This study describes the frequency of consultation, causative diagnoses, and presenting characteristics of papilledema at a tertiary care children's hospital.
Methods:
All consecutive patients seen in pediatric ophthalmology consultation or diagnosed with papilledema at a large children's hospital between January 1, 2021, and August 18, 2023, were retrospectively reviewed. Patients with papilledema (disk edema from elevated intracranial pressure) were identified and included in the analysis. Clinical characteristics of their presentations and the diagnoses underlying their elevated intracranial pressures were obtained. Age stratification into three groups for additional analysis was performed.
Results:
A total of 71 patients were identified with papilledema. Mean patient age was 13 ± 5.2 years (range, 0-20 years), and 68% of patients were girls. The overall rate of papilledema diagnosis among all unique patient consultations was 3.7%. Papilledema was caused by idiopathic intracranial hypertension (IIH) in 36 cases (51%), and 35 cases (49%) were due to secondary causes of IHH with serious vision- and life-threatening implications. IIH was most common in children >12 years of age, comprising 60% of papilledema cases in the age group.
Conclusions:
Pediatric papilledema is associated with a wide range of extremely serious underlying conditions that require a comprehensive, multidisciplinary evaluation in an emergency setting.
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