Obesity and Overweight are Highly Prevalent in Pediatric Secondary Pseudotumor Cerebri Syndrome (I12-1B)

OBJECTIVE: Examine the clinical, demographic, and anthropometric patient characteristics of secondary pseudotumor cerebri syndrome (PTCS) in children and adolescents based on the recently revised diagnostic criteria. BACKGROUND: PTCS may be either primary (i.e., idiopathic intracranial hypertension) or secondary to a number of exposures or medical conditions. Obesity influences risk for primary PTCS, however it is less clear whether secondary PTCS is also strongly associated with excess body weight. DESIGN/METHODS: An electronic database search identified cases of PTCS at a tertiary children’s hospital. Cases were classified as either primary PTCS (n=59; 79[percnt]) or secondary PTCS (n=16; 21[percnt]) as rigorously defined by the recently revised diagnostic criteria (Friedman et al., 2013). Outcomes included body-mass index Z-scores (BMI-Z), height and weight Z-scores, demographics, and clinical features at initial presentation such as headache, sixth nerve palsy, and cerebrospinal fluid opening pressure. These retrospective data were collected using bioinformatics-based and manual abstraction and managed using a secure web-based application (www.project-redcap.org). RESULTS: The associated conditions and exposures seen in this secondary PTCS cohort included tetracycline-class antibiotics (n=11), chronic kidney disease (n=3), withdrawal from chronic glucocorticoids (n=1), and lithium (n=1). 79[percnt] of children with secondary PTCS were either overweight or obese (n=11 of 14) including 43[percnt] who were obese (n=6) by U.S. Centers for Disease Control (CDC) classifications, which differs significantly from a national survey reporting 32[percnt] of all children as overweight or obese (p=0.0002; one-proportion test) and 17[percnt] as obese (p=0.0094; one-proportion test) (Ogden et al., 2014). Mean BMI-Z (±SD) was elevated at 1.53±0.93 (p=0.0003, one-mean test vs. national average pediatric BMI-Z of 0.44 (Weber et al., 2014)). CONCLUSIONS: Pediatric patients diagnosed with secondary PTCS were on average significantly overweight compared to their peers. Hence excess body weight may contribute to PTCS even when a potential secondary cause is identified. Study Supported by:5-K12-DK-94723-2(SEM)