Secondary PTC is more common than primary PTC (i.e., pediatric IIH) in children compared with adults. This is helpful in terms of putting more emphasis on finding the underlying cause of PTC in the pediatric population. The typical risk factors and presentation of PTC do not apply to pediatric patients. For example, obesity is one of the major risk factors in adult PTC, but it does not seem to have the same effect in the pediatric population. In a study done at University of Iowa, it was found that only 32% of pediatric patients with PTC were obese (approximating the natural rate in this population), whereas in other studies more than 80% of adults with PTC were obese. Overweight women of childbearing age is the typical presentation of PTC patients. However, in the pediatric population the incidence between male and female is equal. Therefore when a child walks into the doctor's office and is diagnosed with PTC, the physician should be more concerned with secondary causes of PTC.
The course of secondary PTC in children is better than the course of pediatric IIH; and children with PTC or pediatric IIH are less likely to require surgical intervention compared with adult IIH.(This is concluded from a recent study at Iowa which is being submitted for publication)
Adolescents who take tetracycline for their acne may present in clinic with signs of increased intracranial pressure. The mechanism is not well understood but this class of antibiotics compose a large number of patients with PTC. Tetracycline manifestations of PTC is independent of age, gender and obesity. It is not clear as to how much exposure and what duration is needed to trigger PTC. However in one of the largest studies of PTC patients who were exposed to Minocycline; there was a huge range between 2 weeks up to 1 year of minocycline use before patients became symptomatic. -Renal Failure:
Renal failure was reported by Dogulu et al. In their study eight patients with renal failure were found to have PTC. -Vitamin A -Leukemia -Lupus Recent studies on PTC have characterized the common etiologies that would lead to PTC in childhood. Four different studies including a study of 68 pediatric patients by baker et al confirmed ear infection as one of the most common etiologies of PTC in children. However, in another study done by Couch et al among 38 children with pseudotumor cerebri only 3 cases were due to ear infection or its complications. Furthermore, in other studies, PTC has been associated with obesity, recent weight gain, female gender, and steroid withdrawal. Tetracycline use, Vitamin A derivatives, systemic diseases, and venous thrombosis have also been reported as common causes of secondary PTC.
There could be patients with PTC who do not have any papilledema, or who have unilateral or asymmetrical papilledema. -Sixth nerve palsy: usually leads to diplopia -Loss of visual acuity or a visual field defect -Pulse Synchronous Tinnitus: Wooshing noise in the ear
-Friedman DI, Jacobson DM. "Diagnostic criteria for idiopathic intracranial hypertension". Neurology 2002;59:1492–1495.
-Durcan FJ, Corbett JJ, Wall M. "The incidence of pseudotumor cerebri. Population studies in Iowa and Louisiana". Arch Neurol 1988;45:875-7.
-Baker RS, Carter D, Hendrick EB, Buncic JR: "Visual loss in pseudotumor cerebri of childhood: A follow-up study". Arch Ophthalmol 103:1681–1686, 1985.
-Ingrid U. Scott; R. Michael Siatkowski; Mazen Eneyni; Michael C. Brodsky; Byron L. Lam "Idiopathic intracranial hypertension in children and adolescents". American Journal of Ophthalmology, August 1997 v124 n2 p253(3).
-Corbett JJ, Thompson HS: The rational management of idiopathic intracranial hypertension. Arch Neurol 46:1049–1051, 1989.
-Couch R, Camfield PR, Tibbles JA. "The changing picture of pseudotumor cerebri in children". Can J Neurol Sci, 1985 Feb;12(1):48-50.