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. 2025 Sep 15;184(10):618.
doi: 10.1007/s00431-025-06389-x.

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

Lotem Goldberg #  1   2 , Gad Dotan #  3   4 , Nina Shirman Erel  5   3 , Hila Weisblum Neuman  5   3 , Keren Smuel Zilberberg  5   3 , Danielle Kadishevich  5   3 , Yehonatan Pasternak  3   6 , Idan Goldberg  3   7 , Yoel Levinsky  5   3 , Dror Kraus  3   8 , Oded Scheuerman  5   3
Affiliations

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

Lotem Goldberg et al. Eur J Pediatr. .

Abstract

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.

Keywords: Diagnostic workup; Headache; Intracranial hypertension; Pseudotumor cerebri; Secondary causes.

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Conflict of interest statement

Declarations. Ethics approval: The study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Research Ethics Board of Rabin Medical Center, which waived the requirement for informed consent. Competing Interests: The authors declare no competing interests. Conflicts of interest: The authors have no relevant financial or non-financial interests to disclose.

Figures

Fig. 1
Fig. 1
Laboratory workup in SCMCI
See this image and copyright information in PMC

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