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Etiological workup of pseudotumor cerebri in pediatric patients-is it really necessary?
Lotem Goldberg1,2, Gad Dotan3,4, Nina Shirman Erel5,3
1Department of Pediatrics B, Schneider Childrens Medical Center of Israel, Petah Tiqva, Israel. lotemgo@clalit.org.il.
Insights
Extensive laboratory workups for pediatric pseudotumor cerebri (PTC) are often unnecessary. Most causes of PTC can be identified through history and physical exams, reducing patient burden.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Clinical Diagnostics
Background:
- Pseudotumor cerebri (PTC) is a common cause of headaches in children, often necessitating extensive laboratory workups to rule out secondary causes.
- The diagnostic value and clinical utility of these comprehensive laboratory assessments for PTC remain unclear.
- Current guidelines recommend extensive workups, but the actual benefit has not been thoroughly evaluated.
Purpose of the Study:
- To evaluate the clinical yield and diagnostic significance of extensive laboratory workups in children diagnosed with pseudotumor cerebri.
- To determine if the routine laboratory assessment for PTC provides additional diagnostic information beyond medical history and physical examination.
- To assess the necessity of extensive laboratory workups in a pediatric tertiary care setting.
Main Methods:
- Retrospective study conducted in a pediatric tertiary medical center.
- Inclusion criteria: children hospitalized between 2010-2020 with a new diagnosis of definite PTC.
- Review of abnormal laboratory results by two pediatricians for clinical significance.
Main Results:
- 75 children with PTC were included (58.7% girls, mean age 10.9 years).
- Secondary causes were identified in 20%, and 28% had pre-existing conditions; overweight was common (mean BMI 24.53 kg/m²).
- Vitamin D insufficiency was prevalent (68%), but no additional secondary PTC cases were diagnosed through the extensive workup beyond drug-related causes and overweight.
- The most common identifiable etiologies, besides being overweight, were drug-related.
Conclusions:
- Most etiologies of pseudotumor cerebri in children can be identified through a thorough medical history and physical examination.
- Extensive laboratory workups may not be routinely required for diagnosing PTC, potentially reducing patient discomfort and healthcare costs.
- Measuring Vitamin D levels may still be relevant, but other extensive tests might be unnecessary.
Abstract:
Pseudotumor cerebri (PTC) is a relatively common cause of headaches in children. In order to exclude secondary causes, an extensive laboratory workup is generally recommended. This assessment causes blood loss, discomfort and a financial burden. To our knowledge, the diagnostic significance of such workup is unclear. We aimed to evaluate the clinical yield of PTC laboratory workup in a pediatric tertiary medical center. This is a retrospective study in a tertiary pediatric hospital. Included were children hospitalized between 2010-2020 with new diagnosis of definite PTC, as confirmed by a certified pediatrician and ophthalmologist. Abnormal results were reviewed by two pediatricians for clinical significance. 75 children (58.7% girls, mean age 10.9 ± 4.25 years) with PTC were included. Secondary known causes for PTC were found in 20%, and 28% had other pre-existing medical conditions. Mean BMI was 24.53 ± 8.65 kg/m2. Vitamin D insufficiency (< 50 nmol/L) was diagnosed in 68%, with over half with deficiency (less than 30 nmol/L). Other than being overweight, the most common identifiable etiologies of PTC were drug-related. No additional secondary cases were diagnosed due to the extended work-up.
Conclusion:
Our findings suggest that most PTC etiologies can be identified through medical history and physical examination, which may imply that an extensive laboratory work-up, except for vitamin D levels, may not be routinely required.
What Is Known:
• An extensive laboratory workup is routinely recommended to exclude secondary PTC. • The clinical utility of PTC workup has not been assessed.
What Is New:
• A comprehensive medical history and physical examination probably suffices to diagnose secondary PTC. • An extensive laboratory work-up, except for vitamin D levels, may not be routinely required.
