Secondary Intracranial Hypertension in Pediatric Hemato-Oncology Patients

Publication date: Available online 1 September 2017
Source:Pediatric Neurology
Author(s): Miguel Ángel Fernández-García, Verónica Cantarín-Extremera, Maitane Andión-Catalán, Anna Duat-Rodríguez, Saioa Jiménez-Echevarría, Ignacio Bermejo-Arnedo, Montesclaros Hortigüela-Saeta, Saray Rekarte-García, Lara Babín-López, David Ruano Domínguez
Objectives. To investigate the clinical characteristics of a pediatric population with hemato-oncological disease with intracranial hypertension; to analyse the therapeutic response and outcome, and discuss and compare its differential characteristics with respect to a control group of idiopathic intracranial hypertension (IIH). Methods. Retrospective descriptive study of patients with hemato-oncological disease and secondary intracranial hypertension in our centre in the past five years. Comparison with a historical cohort with IIH from our institution (control group). Main findings. We identified 8 patients and 21 controls. Mean age at diagnosis was 10.6 years, and 62% of individuals were female. Most of them were under treatment with drugs (62% corticosteroids, 75% active chemotherapy). Mean opening pressure of cerebrospinal fluid (CSF) was 35 cmH2O. All suffered from headache, but only 28% complained of visual symptoms. Only 12.5% showed papilledema at diagnosis (versus 71% in controls). All of them were treated with acetazolamide, with average therapy duration of nine months, and had a favourable outcome (versus 57% of controls who needed second-line treatment). None of them showed long-term visual complications (versus 20% of controls). Conclusions. Patients with hemato-oncological disease and secondary intracranial hypertension may not develop typical symptomatology. Thus, diagnosis and recognition of this entity among this cohort may be complicated. Associated factors are diverse and do not show any obvious causal relationship. A high index of suspicion must be maintained for diagnosis, since a favourable outcome is expected with prompt treatment. Acetazolamide is effective as a first-line therapy with no significant side effects.



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