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Arch Dis Child. 2017 Mar 29. pii: archdischild-2016-312238. doi: 10.1136/archdischild-2016-312238. [Epub ahead of print]

Pseudotumor cerebri syndrome in childhood: incidence, clinical profile and risk factors in a national prospective population-based cohort study.

Author information

1
Paediatric Department, Wrexham Maelor Hospital, Wrexham, UK.
2
Ophthalmology Department, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK.
3
Department of Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London, UK.
4
Paediatric Department, University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK.
5
Division of Cardiovascular and Respiratory Medicine, University of Hull, Hull, UK.
6
Department of Paediatric Neurosurgery, Birmingham Children's Hospital, University of Birmingham, Birmingham, UK.
7
Department of Child Health, Morriston Hospital, Swansea, UK.
8
Department of Paediatric Neurology, School of Medicine, University of Nottingham, Nottingham University Hospitals NHS Trust, Nottingham, UK.
9
Clinical Neurosciences, Faculty of Medicine, University of Southampton, University Hospital Southampton, Southampton, UK.

Abstract

AIM:

To investigate the epidemiology, clinical profile and risk factors of pseudotumor cerebri syndrome (PTCS) in children aged 1-16 years.

METHODS:

A national prospective population-based cohort study over 25 months. Newly diagnosed PTCS cases notified via British Paediatric Surveillance Unit were ascertained using classical diagnostic criteria and categorised according to 2013 revised diagnostic criteria. We derived national age, sex and weight-specific annual incidence rates and assessed effects of sex and weight categories.

RESULTS:

We identified 185 PTCS cases of which 166 also fulfilled revised diagnostic criteria. The national annual incidence (95% CI) of PTCS in children aged 1-16 years was 0.71 (0.57 to 0.87) per 100 000 population increasing with age and weight to 4.18 and 10.7 per 100 000 in obese boys and girls aged 12-15 years, respectively. Incidence rates under 7 years were similar in both sexes. From 7 years onwards, the incidence in girls was double that in boys, but only in overweight (including obese) children. In children aged 12-15 years, an estimated 82% of the incidence of PTCS was attributable to obesity. Two subgroups of PTCS were apparent: 168 (91%) cases aged from 7 years frequently presented on medication and with headache and were predominantly female and obese. The remaining 17 (9%) cases under 7 years often lacked these risk factors and commonly presented with paralytic squint.

CONCLUSIONS:

This uniquely large population-based study of childhood PTCS will inform the design of future intervention studies. It suggests that weight reduction is central to the prevention of PTCS.

KEYWORDS:

BPSU; Epidemiology; Obesity; idiopathic intracranial hypertension; pseudotumor cerebri

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