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Pseudotumour Cerebri Syndrome in China: A Cohort Study.

ABSTRACT: Pseudotumour cerebri syndrome (PTCS) remains to be fully investigated in Chinese patients and our study reported PTCS-related clinical differences between Chinese patients and Western patients. This study enrolled 55 consecutive patients (females: 44, median age: 37?y, age range: 14-62?y) with PTCS diagnosed from October 2015 to December 2017. Nine (16.4%, females) patients had primary PTCS, and 46 (83.6%) had secondary PTCS (P?=?0.001). At presentation, 81.8% of patients had grade >3 papilloedema, with 23.6% having diffusely constricted fields. Mean subarachnoid space around the optic nerve measured by retrobulbar ultrasonography during lumbar puncture was 1.12?±?0.17?mm and decreased to 0.86?±?0.11?mm after treatment. Optical coherence tomography (OCT) showed that 92.9% of eyes with intact macular ganglion cell-inner plexiform layer (GCIPL) at baseline had good outcomes after treatment. Patients' demographic and clinical characteristics showed that secondary PTCS was more common than primary idiopathic intracranial hypertension in Chinese patients. Polycystic ovarian syndrome was the main associated factor in females. Poor visual function was common at presentation. Noninvasive ocular ultrasonography and OCT are the prognostic indicators of PTCS treatment in intracranial pressure and visual function, respectively, after PTCS treatment.

SUBMITTER: Chen Q

PROVIDER: S-EPMC6985260 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Pseudotumour Cerebri Syndrome in China: A Cohort Study.

Chen Qian Q Feng Chaoyi C Zhao Guixian G Chen Weimin W Wang Min M Sun Xinghuai X Sha Yan Y Li Zhenxin Z Tian Guohong G

Scientific reports 20200127 1

Pseudotumour cerebri syndrome (PTCS) remains to be fully investigated in Chinese patients and our study reported PTCS-related clinical differences between Chinese patients and Western patients. This study enrolled 55 consecutive patients (females: 44, median age: 37 y, age range: 14-62 y) with PTCS diagnosed from October 2015 to December 2017. Nine (16.4%, females) patients had primary PTCS, and 46 (83.6%) had secondary PTCS (P = 0.001). At presentation, 81.8% of patients had grade >3 papilloede ...[more]

PMID: 31988364

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Project description:BackgroundIdiopathic intracranial hypertension (IIH), also known as pseudotumour cerebri syndrome (PTCS), is characterized by the presence of signs and symptoms of raised intracranial pressure without evidence of any intracranial structural cause and with normal cerebrospinal fluid microscopy and biochemistry. Obesity, various systemic diseases and endocrine conditions, and a number of medications are known to be risk factors for PTCS. The medications commonly associated with PTCS are amiodarone, antibiotics, corticosteroids, cyclosporine, growth hormone, oral contraceptives, vitamin A analogues, lithium, phenytoin, NSAIDs, leuprolide acetate, and some neuroleptic drugs. In relation to antibiotics, quinolones may cause intracranial hypertension, and most reported cases of quinolone-induced intracranial hypertension were associated with nalidixic acid, ciprofloxacin, ofloxacin, or pefloxacin. Literature reports of levofloxacin-induced PTCS are rare. Some authors recently hypothesized that Mycoplasma pneumoniae may trigger PTCS.Case presentationWe report on a 14-year-old overweight White Italian boy who suffered headache, diplopia, and severe bilateral papilloedema after a Mycoplasma pneumoniae infection, exacerbated on levofloxacin intake. A spontaneous improvement in headache and a reduction in diplopia was seen during hospitalisation. Oral acetazolamide therapy led to the regression of papilloedema in about five months. No permanent eye damage has been observed in our patient to date.ConclusionsPTCS pathophysiology may be multifactorial and its specific features and severity may be a consequence of both constitutional and acquired factors interacting synergistically. It may be useful for paediatricians to know that some antibiotics may have the potential to precipitate PTCS in patients who already have an increased CSF pressure due to a transitory imbalanced CSF circulation caused by infections such as Mycoplasma pneumoniae, with headache being the first and most sensitive, but also the least specific, symptom.

Project description:ImportancePediatric pseudotumor cerebri syndrome pathophysiology is complex and not well delineated. Therefore, it is important to identify potential contributors or targets underlying the primary pathogenesis for its development.ObjectiveTo report cases highlighting the association of pediatric pseudotumor cerebri syndrome with adrenal insufficiency.Design, setting, and participantsThis noncontrolled, observational case series included pediatric patients diagnosed with pseudotumor cerebri syndrome and adrenal insufficiency at an urban academic children's hospital in Houston, Texas, from June 2015 to October 2019.Main outcomes and measuresMonitoring optic nerve edema by clinical examination, fundus photography, and optical coherence topography images of the optic nerve.ResultsData were collected from 5 pediatric patients (age range, 5-10 years) diagnosed with pseudotumor cerebri syndrome and adrenal insufficiency. One was a girl; all were White and prepubertal. Three patients had unrecognized glucocorticoid exposure. All patients had bilateral optic nerve edema that was initially treated with acetazolamide or topiramate, but cortisol functional testing by either 8 am cortisol or cosyntropin stimulation tests revealed a diagnosis of central adrenal insufficiency. Treatment with physiological doses of hydrocortisone resulted in resolution of optic nerve edema and clinical symptoms of pseudotumor cerebri syndrome, as well as a shorter time receiving medical therapy.Conclusions and relevanceIn this case series, adrenal insufficiency was associated with both primary and secondary prepubertal pediatric pseudotumor cerebri syndrome. As a potential target specific to causative mechanism, physiologic hydrocortisone therapy resolved the condition. To date, there remains a global unawareness among clinicians about the suppressive outcome that glucocorticoids may have on the developing hypothalamic-pituitary-adrenal axis, resulting in adrenal insufficiency and so-called episodic pseudotumor cerebri syndrome in young children. Ophthalmologists and pediatric subspecialists should implement cortisol testing via either 8 am cortisol or cosyntropin stimulation tests at initial evaluation of all children with pseudotumor cerebri syndrome and risk factors for adrenal insufficiency, no predisposing causes, or nonresponse to conventional treatment. Further management and treatment should be in combination with ophthalmology and endocrine services.

Project description:BackgroundEarly recognition of the risks of acute respiratory distress syndrome (ARDS) and prevention of the development of ARDS may be more effective in improving patient outcomes. We performed the present study to determine the ARDS risk factors in a Chinese population and validate a score to predict the development of ARDS.MethodsThis was an observational multicenter cohort study performed in 13 tertiary hospitals in China. Patients admitted into participating intensive care units (ICUs) from January 1 to January 31, 2012, and from January 1 to January 10, 2013, were enrolled in a retrospective derivation cohort and a prospective validation cohort, respectively. In the derivation cohort, the potential risk factors of ARDS were collected. The confirmed risk factors were determined with univariate and multivariate logistic regression analyses, and then the modified ARDS prediction score (MAPS) was established. We prospectively enrolled patients to verify the accuracy of MAPS.ResultsA total of 479 and 198 patients were enrolled into the retrospective derivation cohort and the prospective validation cohort, respectively. A total of 93 (19.4%) patients developed ARDS in the derivation cohort. Acute pancreatitis, pneumonia, hypoalbuminemia, acidosis, and high respiratory rate were the risk factors for ARDS. The MAPS discriminated patients who developed ARDS from those who did not, with an area under the curve (AUC) of 0.809 [95% confidence interval (CI), 0.758-0.859, P<0.001]. In the prospective validation cohort, performance of the MAPS was similar to the retrospective derivation cohort, with an AUC of 0.792 (95% CI, 0.717-0.867, P<0.001). The lung injury prediction score (LIPS) showed a predicted value of an AUC of 0.770 (95% CI, 0.728-0.812, P<0.001) in our patients, which was significantly lower than our score (P<0.046).ConclusionsThe MAPS based on risk factors could help the clinician to predict patients who will develop ARDS.Trial registrationClinicalTrials.gov NCT01666834.

Dataset Information

Pseudotumour Cerebri Syndrome in China: A Cohort Study.

Publications

Pseudotumour Cerebri Syndrome in China: A Cohort Study.

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