Modified Dandy vs. PTSC for diagnosis of pediatric intracranial hypertension

This retrospective review compares the modified Dandy with the new pseudotumor cerebri syndrome (PTCS) criteria for diagnosing children with intracranial hypertension (IH).

Study design

The study included 50 consecutive patients who were examined in the pediatric IH clinic at Nationwide Children's Hospital (Columbus, Ohio) between May 2010 and June 2013. Of these patients, 40 had primary IH and 10 had secondary IH, according to modified Dandy criteria. The authors retrospectively applied PTCS criteria to all 50 patients and assessed how many met the criteria for IH.

Outcomes

Following application of the PTSC criteria, children were categorized into 3 groups: definite PTCS (n=31, 62%), probable PTCS (n=10, 20%) and insufficient evidence for diagnosis of PTCS (n=9, 18%).

Limitations

Non-compliance to treatment and/or poor follow-up may have complicated the retrospective analysis. Lumbar punctures were performed in different clinical settings, possibly by clinicians with varying skill levels.

Clinical significance

Unlike modified Dandy criteria, the PTCS criteria stratify IH diagnosis into definite, probable and suggested categories. The PTCS criteria exclude the use of clinical symptoms and rely more heavily on radiologic evidence.

Diagnosing and treating pediatric IH remains an art. A combination of modified Dandy criteria and PTCS criteria should be applied, as both clinical symptoms and radiologic findings are important in diagnosing and treating IH. Physicians should be aware that the absence of radiographic findings should not rule out IH, and some patients can have IH without papilledema. Even without ocular abnormalities, IH can still produce symptoms that may be alleviated by systemic treatment.