Abstract Details

Title Is MRI Always Necessary in Pediatric Patients with Papilledema Without Atypical Features?

Topic Child Neurology and Developmental Neurology

Presentation(s) S38 - Child Neurology and Developmental Neurology: Acquired Brain Injury: Brain-Behavior Relationships (1:48 PM-2:00 PM)

Poster/Presentation
Number 005

Objective

Investigate if computed tomography (CT) of the brain is sufficient for evaluation of pediatric papilledema with normal neurologic features.

Background Papilledema is a sign of increased intracranial pressure, and can be caused by disorders, such as brain tumor, cerebral venous thrombosis (CVT), or idiopathic intracranial hypertension (IIH). There are no studies to date investigating, with an otherwise normal neurological evaluation, if CT is sufficient in the evaluation of pediatric papilledema.

Design/Methods We reviewed medical records of children aged 18 years or younger between 2012-2019 with diagnostic codes for papilledema/optic disc edema, IIH, brain tumor, or CVT. Our study had 2 parts: 1) for patients presenting with papilledema and an otherwise normal neurological evaluation, we reviewed their CT and magnetic resonance imaging (MRI) to compare diagnostic yield, and 2) for all patients (with or without papilledema) diagnosed with brain tumor or CVT, we reviewed their clinical presentation and diagnostic yield of imaging.

Results Part 1: During 2012-2019, 125 pediatric patients with papilledema presented with otherwise normal neurologic features. 18 patients had both CT and MRI -- all 3 brain tumors were seen on CT, and none had CVT. An additional 9 patients had CT only – papilledema resolved in all 9 with no clinical worsening characteristic of brain tumor or CVT. Part 2: In patients with brain tumors, tumors were identified on CT in 53/54 patients. The single patient with a normal CT presented with focal seizures and a focal neurologic exam. In CVT patients, 10/13 had an abnormal CT; all 3 patients with normal CT presented with other abnormal neurologic features (seizures, mental status changes, abnormal exam) that had already prompted further evaluation.

Conclusions In children with papilledema and otherwise normal neurological evaluation, CT imaging may be sufficient. Between 2012-2019, no actionable pathology was missed with CT in children with normal neurologic features.

Authors/Disclosures
Travis Larsh, MD (Cincinnati Children's Hospital Medical Center) PRESENTER	Dr. Larsh has nothing to disclose.
Gary Hsich, MD (Cleveland Clinic)	No disclosure on file

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