Bilateral disc drusen as an important differential diagnosis of pseudotumor cerebri

Abstract

We read with great interest the article by Distelmaier et al. [ [1] Distelmaier F. Assmann B. Mayatepek E. Rosenbaum T.H. Pseudotumor cerebri as an important differential diagnosis of papilledema in children. Brain Dev. 2006; 28: 190-195 Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar ] on “pseudotumor cerebri as an important differential diagnosis of papilledema in children”. The incidence of pseudotumor cerebri is rare, and so the incidence of drusen [ [2] Mullie M.A. Sanders M.D. Scleral canal size and optic nerve drusen. Am J Ophthalmol. 1985; 99: 356-359 Abstract Full Text PDF PubMed Google Scholar ], which must be taken into account in the differential diagnosis of papilledema. Drusen are inherited as an autosomal dominant trait and its incidence is higher in European than other ethnic groups. The diagnosis of papilledema is not always easy [ [3] Fenichel GM, Clinical pediatric neurology. A signs and symptoms approach. 4th ed. Philadelphia: W.B. Saunders Company; 2001, p. 93–5. Google Scholar ] for, among other reasons, congenital variations of disk appearance. It may implies an important challenge. On the other hand, although we know that primary pseudotumor cerebri is defined as elevated cerebrospinal (CSF) fluid pressure of more than 20 cm H2O, normal CSF composition, and exclusion of underlying structural or systemic causes, we experience in practice that initially any disease may in fact make debut without a complete pattern of manifestations. A further aspect to be considered, when we are approaching a patient with a clinical picture of papilledema, is the growing incidence of somatization, particularly in teenagers.