Psödotümör Serebri; Tek Merkez Deneyimi

Yıl 2019, Cilt: 13 Sayı: 3, 193 - 202, 24.05.2019

Yasemin Özkale

https://doi.org/10.12956/tjpd.2018.364

Öz

Amaç: Çalışma, psödotümör serebri tanısı konulan olgularımızın klinik, laboratuvar bulgularını ve tedavilerini geriye dönük olarak gözden geçirmek ve 2013 yılında Friedman ve ark. tarafından yeniden belirlenen tanı ölçütlerine göre hastaları yeniden tanımlayarak literatür ile karşılaştırmak amacıyla planlanmıştır. 

Gereç ve Yöntemler: Çocuk Nöroloji Kliniği’nde 40 psödotümör serebri tanılı hastalar klinik bulguları ve tedavileri yönünden geriye dönük olarak incelendi. Tanılar Modifiye Dandy kriterleri ve 2013 Friedman tanı ölçütlerine göre tekrar karşılaştırıldı. 

Bulgular: Modifiye Dandy kriterlerine göre “kesin psödotümör serebri” tanısı alan 40 hastanın 2013 tanı kriterlerine göre tekrar sınıflandırıldığında 37’sinin tanısında değişiklik olmazken, üç hastanın “olası psödotümör serebri” grubuna kaydığı görüldü. Hastaların yaş ortalaması 11.15±3.32 yıl olup, %40’ı prepübertal, %60’ı pübertal dönemde idi. Yirmi sekiz hastaya (%70) birincil psödotümör serebri, 12 hastaya ise ikincil psödotümör serebri (%30) tanısı kondu. Baş ağrısı hastaların en sık başvuru şikayeti (%55)’di. Tüm hastaların medikal tedavi aldığı saptandı. Tedaviye yanıt vermeyen bir hastaya ise lumboperitoneal şant takıldığı tespit edildi. 

Sonuç: Hastalarımızın belirti ve bulgularının literatür ile uyumlu olduğu görüldü. Birincil psödotümör serebrili hastalarımızın %53.5’nin obezite ile ilişkili olduğu, ikincil psödotümör serebri nedenleri açısından ise nedenlerin literatür ile benzeştiği ve çoğunun medikal tedaviye yanıt verdiği gözlendi. Eski ve yeni tanı ölçütlerinin kullanılmasının tanı ve tedavi açısından farklılık yaratmayacağı saptandı. 

Anahtar Kelimeler

Çocuk, 2013 Friedman kriterleri

Kaynakça

• 1. Phillips PH, Sheldon CA. Pediatric pseudotumor cerebri syndrome. J Neuroophthalmol 2017;37:33–40.
• 2. Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 2013;81:1159-65.
• 3. Spennato P, Ruggiero C, Parlato RS, et al. Pseudotumor cerebri. Childs Nerv Syst 2011;27:215–35.
• 4. Tibussek D, Schneider DT, Vandemeulebroecke N, Turowski B, Messing-Juenger M, Willems PH, et al. Clinical spectrum of the pseudotumor cerebri complex in children. Childs Nerv Syst 2010;26:313-21.
• 5. Wraige E, Chandler C, Pohl KR. Idiopathic intracranial hypertension: Is papil edema inevitable? Arch Dis Child 2002;87:223-4.
• 6. Per H, Canpolat M, Gümüş H, Poyrazoğlu HG, Yıkılmaz A, Karaküçük S, et al. Clinical spectrum of the pseudotumor cerebri in children: Etiological, clinical features, treatment and prognosis. Brain Dev 2013;35:561-8.
• 7. Incecik F, Hergüner MO, Altunbaşak S. Evaluation of sixteen children with pseudotumor cerebri. Turk J Pediatr 2011;53:55-8.
• 8. Değerliyurt A, Teber S, Karakaya G, Güven A, Şeker ED, Arhan EP, et al. Pseudotumor cerebri/idiopathic intracranial hypertension in children: An experience of a tertiary care hospital. Brain Dev 2014;36:690-9.
• 9. Hacifazlioglu N, Yilmaz Y. Pseudotumour cerebri in children: Etiological, clinical features and treatment modalities. Eur J Paediatr Neurol 2012;16:349-55.
• 10. Fuqua JS. Treatment and outcomes of precocious puberty: An update. Clin Endocrinol Metab 2013;98:2198-207.
• 11. Masri A, Jaafar A, Noman R, Gharaibeh A, Ababneh OH. Intracranial hypertension in children: Etiologies, clinical features, and outcome. J Child Neurol 2015;30:1562-8.
• 12. Avery RA, Shah SS, Licht DJ, et al. Reference range for cerebrospinal fluid opening pressure in children. N Engl J Med 2010;363:891-3.
• 13. Smith JL. Whence pseudotumor cerebri?. J Clin Neuroophthalmol 1985;5:55-6.
• 14. Cleves-Bayon C. Idiopathic Intracranial Hypertension in Children and Adolescents: An Update. Headache 2018;58:485-93.
• 15. Tibussek D, Distelmaier F, Karenfort M, Harmsen S, Klee D, Mayatepek E. Probable pseudotumor cerebri complex in 25 children. Further support of a concept. Eur J Paediatr Neurol 2017;21:280-5.
• 16. Inger HE, Rogers DL, McGregor ML, Aylward SC, Reem RE. Diagnostic criteria in pediatric intracranial hypertension. J AAPOS 2017;21:492-5.
• 17. Maralani PJ, Hassanlou M, Torres C, et al. Accuracy of brain imaging in the diagnosis of idiopathic intracranial hypertension. Clin Radiol 2012;67:656-63.
• 18. Gorkem SB, Doganay S, Canpolat M, et al. MR imaging findings in children with pseudotumor cerebri and comparison with healthy controls. Childs Nerv Syst 2015;31:373-80.
• 19. Tibussek D, Schneider DT, Vandemeulebroecke N, et al. Clinical spectrum of the pseudotumor cerebri complex in children. Childs Nerv Syst 2010;26:313-21.
• 20. Kesler A, Fattal-Valevski A. Idiopathic intracranial hypertension in the pediatric population. J Child Neurol 2002;17:745-8.
• 21. Couch R, Camfield PR, Tibbles JA. The changing picture of pseudotumor cerebri in children. Can J Neurol Sci 1985;12:48-50.
• 22. Standridge SM. Idiopathic intracranial hypertension in children: A review and algorithm. Pediatr Neurol 2010;43:377-90.
• 23. Matthews YY, Dean F, Lim MJ, et al. Pseudotumor cerebri Syndrome in childhood: Incidence, clinical profile and risk factors in a national prospective population-based cohort study. Arch Dis Child 2017;102:715-21.
• 24. Sinclair AJ, Walker EA, Burdon MA, et al. Cerebrospinal fluid corticosteroid levels and cortisol metabolism in patients with idiopathic intracranial hypertension: A link between 11beta-HSD1 and intracranial pressure regulation? J Clin Endocrinol Metab 2010;95:5348-56.
• 25. Sinclair AJ, Onyimba CU, Khosla P, et al. Corticosteroids, 11betahydroxysteroid dehydrogenase isozymes and the rabbit choroid plexus. J Neuroendocrinol 2007;19:614-20.
• 26. Salpietro V, Polizzi A, Berte LF, et al: Idiopathic intracranial hypertension: A unifying neuroendocrine hypothesis through the adrenal- brain axis. Neuro Endocrinol Lett 2012;33:569–73.
• 27. Randhawa S, Van Stavern GP. Idiopathic intracranial hypertension (pseudotumor cerebri). Curr Opin Ophthalmol 2008;19:445-53.
• 28. Distelmaier F, Tibussek D, Schneider DT, Mayatepek E. Seasonal variation and atypical presentation of idiopathic intracranial hypertension in prepubertal children. Cephalalgia 2007;27:1261-4.
• 29. Keren T, Lahat E. Pseudotumor cerebri as a presenting symptom of acute sinusitis in a child. Pediatr Neurol 1998;19:153-4.
• 30. Lin A, Foroozan R, Danesh-Mayer HV, De Salvo G, Savino PJ, Sergott RC. Occurence of cerebral venous sinus thrombosis in patients with presumed idiopathic intracranial hypertension. Ophthalmology 2006;113:2281-4.
• 31. Standridge SM, O’Brien SH. Idiopathic intracranial hypertension in a pediatric population: A retrospective analysis of the initial imaging evaluation. J Child Neurol 2008;23:1308-11.
• 32. Paley GL, Sheldon CA, Burrows EK, Chilutti MR, Liu GT, Mc Cormack SE. Overweight and obesity in pediatric secondary pseudotumor cerebri syndrome. Am J Ophthalmol 2015;159:344- 52.
• 33. Benzimra JD, Simon S, Sinclair AJ, Mollan SP. Sight-threatening pseudotumour cerebri associated with excess vitamin A supplementation. Pract Neurol 2015;15:72-3.
• 34. Raeeskarami SR, Shahbaznejad L, Assari R, Aghighi Y. Pseudotumor cerebri as the first manifestation of juvenile systemic lupus erythematosus. Iran J Pediatr 2016;26:5176.
• 35. Kim JM, Kwok SK, Ju JH, Kim HY, Park SH. Idiopathic intracranial hypertension as a significant cause of intractable headache in patients with systemic lupus erythematosus: A 15-year experience. Lupus 2012;21:542–7.
• 36. Henry M, Driscoll MC, Miller M, Chang T, Minniti CP. Pseudotumor cerebri in children with sickle cell disease: A case series. Pediatrics 2004;113:265-9.
• 37. Tugal O, Jacobson R, Berezin S, et al. Recurrent benign intracranial hypertension due to iron deficiency anemia. Case report and review of the literature. Am J Pediatr Hematol Oncol 1994;16:266– 70.
• 38. Lessel S: Pediatric pseudotumor cerebri (idiopathic intracranial hypertension). Surv Ophthalmol 1992;37:155–66.
• 39. Wall M, Kupersmith MJ, Kieburtz KD, et al. The idiopathic intracranial hypertension treatment trial: Clinical profile at baseline. JAMA Neurol 2014;71:1327-8.40. Wall M, George D. Idiopathic intracranial hypertension. A prospective study of 50 patients. Brain 1991;114:155.
• 41. Corbett JJ, Savino PJ, Thompson HS, et al. Visual loss in pseudotumor cerebri. Follow-up of 57 patients from five to 41 years and a profile of 14 patients with permanent severe visual loss. Arch Neurol 1982;39:461-74.
• 42. Lessell S, Rosman NP: Permanent visual impairment in childhood pseudotumor cerebri. Arch Neurol 1986;43:801–4.
• 43. Miller NR, Newman NJ: Papilledema. In: Walsh F, Hoyt B (eds). Clinical Neuroophthalmology. 5th ed. Baltimore: Williams & Wilkins, 1998:478–548.
• 44. Friedman DI: Pseudotumor cerebri. Neurosurg Clin North Am 1999;10:609–21.
• 45. Babikian P, Corbett J, Bell W. Idiopathic intracranial hypertension in children:The Iowa experience. J Child Neurol 1994;9:144–9.
• 46. Tovia E, Reif S, Oren A, Mitelpunkt A, Fattal-Valevski A. Treatment response in pediatric patients with pseudotumor cerebri syndrome. J Neuroophthalmol 2017;37:393-7.
• 47. Aylward SC, Way AL. Pediatric intracranial hypertension: A current literature review. Curr Pain Headache Rep 2018;22:14.
• 48. Celebisoy N, Gökçay F, Sirin H, Akyürekli O. Treatment of idiopathic intracranial hypertension: Topiramate vs acetazolamide, an openlabel study. Acta Neurol Scand 2007;116:322-7.
• 49. Orssaud C, Dureau P, Zerah M, et al. Benign childhood intracranial hypertension. J Fr Ophtalmol 2001;24:54-9.
• 50. Altan-Yaycioglu R, Canan H, Saygi S. Intravitreal ranibizumab injection in peripapillary CNVM related to idiopathic intracranial hypertension. J Pediatr Ophthalmol Strabismus 2017;54:27-30.
• 51. Phillips PH, Sheldon CA. Pediatric pseudotumor cerebri syndrome. J Neuroophthalmol 2017;37:33-40.