Prevalencia de drusas de papila en pacientes con hipertensión intracraneal idiopática en una población pediátrica

Juliana E. Paino; Franco Benvenuto; Beatriz López; Viviana Abudi

doi:10.70313/2718.7446.v16.n04.260

Authors

Juliana E. Paino Servicio de Oftalmología, Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
Franco Benvenuto Servicio de Oftalmología, Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
Beatriz López Servicio de Oftalmología, Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
Viviana Abudi Servicio de Oftalmología, Hospital de Pediatría S.A.M.I.C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina

DOI:

https://doi.org/10.70313/2718.7446.v16.n04.260

Keywords:

optic disc drusen, idiopathic intracranial hypertension, papiledema, pseudotumor cerebri

Abstract

Objective: To evaluate the prevalence of drusen in patients with idiopathic intracranial hypertension at a tertiary pediatric care hospital.

Methods: A retrospective study was conducted, where medical records of children under 18 years of age seen between 2018 and 2023, with idiopathic intracranial hypertension criteria and elevated opening pressure ere evaluated. We sought to detect the presence of drusen, by ultrasound and optical coherence tomography. Potential associations between drusen detection and parameters such as age (pre/postpubertal), body mass index (normal, overweight, obese) were also analyzed.

Results: Thirty-two patients with idiopathic intracranial hypertension were included, 17 girls (53%) and 15 boys (47%). Mean age was 9.56 (1-14), being 20 prepubertal and 12 postpubertal. In prepubertal, 9 had normal weight, 8 were obese and 3 were overweight and in postpubertal 3 had normal weight, 7 were obese and 2 were overweight. The opening pressure was 33.72 cmH₂O (25-50). 97% presented papilledema (29 bilateral; 1 unilateral), 1 net borders and 4 drusen. Of the 4 patients (13%) with drusen there were no differences in age, clinical presentation and gender, if they presented lower body mass index 19.49 ± 4.25 p=0.04 and 29.5 ± 2.65 (p=0.04). Ninety-four percent responded to treatment.

Conclusion: The prevalence of drusen is higher in patients with idiopathic intracranial hypertension (13%) than in the general population (0.3%-2%). Patients with drusen and idiopathic intracranial hypertension had lower body mass index and opening pressure. The presence of drusen does not rule out the presence of idiopathic intracranial hypertension, and lumbar puncture with opening pressure measurement is necessary in patients with symptoms. Optical coherence tomography allows the diagnosis of drusen and papilledema and the integrity of the nerve.

References

Mollan SP, Davies B, Silver NC et al. Idiopathic intracranial hypertension: consensus guidelines on management. J Neurol Neurosurg Psychiatry 2018; 89: 1088-1100.

Friedman DI, Liu GT, Digre KB. Revised diagnostic criteria for the pseudotumor cerebri syndrome in adults and children. Neurology 2013; 81: 1159-1165.

Gaier ED, Heidary G. Pediatric idiopathic intracranial hypertension. Semin Neurol 2019; 39: 704-710.

Costello F, Rothenbuehler SP, Optic Disc Drusen Studies Consortium et al. Diagnosing optic disc drusen in the modern imaging era: a practical approach. Neuroophthalmology 2020; 45: 1-16.

Aylward SC, Aronowitz C, Roach ES. Intracranial hypertension without papilledema in children. J Child Neurol 2016; 31: 177-183.

Liu B, Murphy RKJ, Mercer D et al. Pseudopapilledema and association with idiopathic intracranial hypertension. Childs Nerv Syst 2014; 30: 1197-1200.

Genizi J, Meiselles D, Arnowitz E et al. Optic nerve drusen is highly prevalent among children with pseudotumor cerebri syndrome. Front Neurol 2021; 12: 789673.

Birnbaum FA, Johnson GM, Johnson LN et al. Increased prevalence of optic disc drusen after papilloedema from idiopathic intracranial hypertension: on the possible formation of optic disc drusen. Neuroophthalmology 2016; 40: 171-180.

Allegrini D, Pagano L, Ferrara M et al. Optic disc drusen: a systematic review: up-to-date and future perspective. Int Ophthalmol 2020; 40: 2119-2127.

Tso MO, Hayreh SS. Optic disc edema in raised intracranial pressure. IV. Axoplasmic transport in experimental papilledema. Arch Ophthalmol 1977; 95: 1458-1462.

Gospe SM 3rd, Bhatti MT, El-Dairi MA. Anatomic and visual function outcomes in paediatric idiopathic intracranial hypertension. Br J Ophthalmol 2016; 100: 505-509.

Teixeira FJ, Marques RE, Mano SS et al. Optic disc drusen in children: morphologic features using EDI-OCT. Eye (Lond) 2020; 34: 1577-1584.

Malmqvist L, Bursztyn L, Costello F et al. The optic disc drusen studies consortium recommendations for diagnosis of optic disc drusen using optical coherence tomography. J Neuroophthalmol 2018; 38: 299-307.

Mangeaud A, Elías Panigo DH. R-Medic: un programa de análisis estadístico sencillo e intuitivo. Methodo 2018; 3: 18-22. Disponible en: https://methodo.ucc.edu.ar/files/vol3/num1/05%20Methodo%202018_03_01%20Bioestadística%20y%20Metodologia%20aplicada%202018_03_01%20R-medic%20Mangeaud%20A%20et%20al.pdf

Chiu HH, Yang FP, VandenHoven C, Wan MJ. Utility of spectral domain OCT in differentiating optic disc drusen from papilledema in children. Can J Ophthalmol 2021; 56: 250-255.

Thompson AC, Bhatti MT, El-Dairi MA. Bruch’s membrane opening on optical coherence tomography in pediatric papilledema and pseudopapilledema. J AAPOS 2018; 22: 38.e3-43.e3.