Pseudotumor Cerebri Syndrome: Reclassification and Follow-Up In A Pediatric Cohort of 126 Argentinean Patients.

Introduction Pseudotumor cerebri syndrome (PTCS) is characterized by increased intracranial pressure with normal neuroimaging, CSF and neurological examination (except the sixth nerve palsy), in absence of other known etiologies. Currently, Friedman's diagnostic criteria apply, with papilledema being the characteristic sign. Puberty, female sex and obesity are recognized as risk factors. The mainstay of medical treatment is acetazolamide and the goal of treatment is to preserve vision.

Objectives To describe and reclassify children diagnosed with PTCS based on Friedman Criteria and to determine the usefulness of OCT as a monitoring method.

Materials and methods Retrospective, descriptive study by reviewing medical records of children with diagnosis of PTCS, between January 2002 and July 2022.

Results 126 patients were included, divided into Group1 “Friedman Criteria” (n:86) and Group2 “Unmet Criteria” (n:40). In both, post-pubertal, female and obese patients predominated. Headache was the most frequent symptom in both, but Group1 associated visual obscurations and tinnitus in 30% (p 0.024). This group more frequently presented flattening of the eyeball and tortuosity of the optic nerve (p 0.03 and p <0.01). At follow-up, pathological OCT at diagnosis, 1 and 3 months predominated in Group1.

Conclusions Diagnosis and follow-up is challenging and is not sufficiently standardized. Overdiagnosis improves significantly with the application of the Friedman Criteria. We highlight the importance of asking about visual obscurations and tinnitus, both closely related to PTCS. The OCT is an objective instrument, that allows detecting papilledema in the early stages of the condition.