Etiological workup of pseudotumor cerebri in pediatric patients-is it really necessary?

UNLABELLED: Pseudotumor cerebri (PTC) is a relatively common cause of headaches in children. In order to exclude secondary causes, an extensive laboratory workup is generally recommended. This assessment causes blood loss, discomfort and a financial burden. To our knowledge, the diagnostic significance of such workup is unclear. We aimed to evaluate the clinical yield of PTC laboratory workup in a pediatric tertiary medical center. This is a retrospective study in a tertiary pediatric hospital. Included were children hospitalized between 2010-2020 with new diagnosis of definite PTC, as confirmed by a certified pediatrician and ophthalmologist. Abnormal results were reviewed by two pediatricians for clinical significance. 75 children (58.7% girls, mean age 10.9 ± 4.25 years) with PTC were included. Secondary known causes for PTC were found in 20%, and 28% had other pre-existing medical conditions. Mean BMI was 24.53 ± 8.65 kg/m2. Vitamin D insufficiency (< 50 nmol/L) was diagnosed in 68%, with over half with deficiency (less than 30 nmol/L). Other than being overweight, the most common identifiable etiologies of PTC were drug-related. No additional secondary cases were diagnosed due to the extended work-up.

CONCLUSION: Our findings suggest that most PTC etiologies can be identified through medical history and physical examination, which may imply that an extensive laboratory work-up, except for vitamin D levels, may not be routinely required.

WHAT IS KNOWN: • An extensive laboratory workup is routinely recommended to exclude secondary PTC. • The clinical utility of PTC workup has not been assessed.

WHAT IS NEW: • A comprehensive medical history and physical examination probably suffices to diagnose secondary PTC. • An extensive laboratory work-up, except for vitamin D levels, may not be routinely required.