Intracranial Pathology Research Articles

The efficacy of laser interstitial thermal therapy in the management of spinal metastases: a systematic review of the literature.

In the last years, laser interstitial thermal therapy (LITT) has started to be used also in neurosurgical setting. Its efficacy for intracranial pathologies, namely, tumors and epilepsy, has been widely demonstrated. However, the literature evidences about the use of LITT for spinal lesions are recent, and it is still a topic of discussion regarding its efficacy. Here, the authors sought to present a systematic review of the literature investigating the utility of LITT for spinal lesions. Using PubMed, Scopus, and the Cochrane Library, the authors performed a systematic review of the literature focused on the use of spinal laser interstitial thermal therapy (sLITT). Included in the search were randomized controlled trials, cohort studies, and clinical series. Two independent reviewers conducted the study appraisal, data abstraction, and quality assessments of the studies. Out of the initial 134 studies, 6 met the inclusion criteria for the systematic review, resulting in a total of 206 patients. All the patients have been treated with sLITT for compressive spinal metastases. Most of the lesions were thoracic (88.8%). All the studies reported an effective local control of the disease with a reduction of epidural compression at 30days. Complication rate was 12.6%, but most of them were transient conditions, and only 3.4% patients needed a revision surgery. sLITT is safe and provides effective local control for epidural compression from metastases, particularly in the thoracic spine. The authors propose considering sLITT as an alternative to open surgery in selected patients with spinal metastases.

Ocular Findings in Children with Headache

ABSTRACT Purpose To determine the prevalence of ophthalmological findings suggesting an ocular cause for headache or occult neurological disease, among children with headache. Methods Retrospective cross-sectional study on children with headache at a tertiary outpatient ophthalmology clinic. All children underwent sensorimotor, anterior segment, and dilated fundoscopic examinations, with or without cycloplegic refraction. Prevalence of one or more new findings of ocular or occult neurological cause of headache, including glaucoma, uveitis, optic nerve elevation, or possible asthenopia from strabismus or refractive issues. Headache characteristics and associated symptoms were evaluated as risk factors for ocular findings. Results Among 1,878 children with headache (mean age 10 yrs, range 2–18), 492 (26.1%, 95% CI 24.3–28.2%) children had one or more new ocular findings that could cause headache or indicate intracranial disease: refractive issues (342, 18.2%), strabismus (83, 4.4%), optic nerve elevation (51, 2.7%; 26 with papilledema, 25 with pseudopapilledema), uveitis (6, 0.3%), and glaucoma (2, 0.1%). Shorter headache duration was associated with ocular findings (p = .047), but headache frequency, photophobia, nausea/vomiting, and visual changes were not. In univariable analysis, visual changes (p ≤ .001), nausea/vomiting (p ≤ .002), and morning headache (p = .02) were associated with optic nerve elevation. Conclusion An ophthalmologic examination including cycloplegic refraction is indicated in children with headache, as one-quarter have a treatable ocular condition, which may be related to the headache, or sign of intracranial pathology. While nausea, visual changes, or morning headache should raise concern, coincident visual, ocular, or systemic symptoms are not reliable predictors of discovering ocular pathology in a child with headache.

Endonasal endoscopic management of spontaneous cerebrospinal fluid rhinorrhoea: The Birmingham UK experience.

Spontaneous cerebrospinal fluid (CSF) leaks (SCSFL) occur in the absence of trauma, surgery, or underlying intracranial pathology. They represent a significant healthcare burden on patients with complications such as meningitis. We present our experience of SCSFL repair via the endonasal endoscopic approach. All patients who underwent CSF fistula repair at a tertiary UK hospital, between 1st January 2012 to 31st December 2019, were identified and had their case notes analyzed retrospectively. There were 33 patients included consisting of 27 (81.8%) females, with age range from 31 to 81 years (mean 55.2). Mean body mass index (BMI) was 35.2kg/m2 , with 32 (97.0%) patients overweight (BMI >25). All patients presented with intermittent watery rhinorrhoea and had a positive biochemical analysis. Computed tomography (CT) and/or magnetic resonance imaging (MRI) identified leak sites in 29 patients (87.9%). The most common intraoperative defect site was the cribriform plate (42.4%). A variety of closing techniques were used including onlay grafts (72.7%), tissue glue (87.9%), nasoseptal flaps (63.6%), mucosal free grafts (21.2%), fat grafts (21.2%), and additional support materials (87.9%). Nasal packing was used in all patients. The average length of stay was 1.6 days. Postoperative complications occurred in two patients (6.1%) (meningitis, epistaxis). Overall, there was a successful primary repair in 32 (97.0%) patients with most cases employing a multilayered reconstruction method (78.8%). Our results demonstrate excellent success rates with the endoscopic endonasal approach to SCSFL. This adds to the literature by demonstrating a detailed analysis of the experience in SCSFL management in one of the largest UK centres.

LITTing up Gliomas—Is the Future Bright?

BackgroundLaser interstitial thermal therapy (LITT) represents an attractive therapeutic strategy for several intracranial pathologies; however, there is a paucity of literature regarding its efficacy for the treatment of gliomas.MethodsMEDLINE, EMBASE, Scopus, and Web of Science were searched from inception until March 19, 2021. Studies specifically relating to the use of LITT in treatment of glioma were eligible for inclusion. A meta-analysis of means was performed to assess the progression-free survival (PFS) and overall survival (OS) following LITT and descriptive statistics relating to patients undergoing LITT were collated and a meta-analysis of proportions was also performed to assess the rate of complications.ResultsIn total, 17 studies were included for the meta-analysis, comprising 401 patients with 408 gliomas of which 88 of 306 (28.8%) were grade 1 or 2 and 218 of 306 (71.2%) were grade 3 or 4. Of these, 256 of 408 (62.8%) were primary presentation and 152 of 408 (37.2%) were recurrent. The pooled mean OS was 13.58 months (95% confidence interval [CI] 9.77–17.39) and the PFS was 4.96 months (95% CI 4.19–5.72). The OS and PFS of recurrent glioblastoma were 12.4 months (95% CI 9.61–16.18) and 4.84 months (95% CI 0.23–9.45), respectively. Complications occurred in 114 of 411 (24%; 95% CI 14–41), of which 44 (11%) were transient deficits.ConclusionsThere is an increasing body of evidence demonstrating the use of LITT in the surgical management of deep-seated gliomas in patients of poor performance status. However, further studies are required to interrogate the clinical effectiveness of LITT in the setting of gliomas as well as assessing the survival benefit versus standard treatment alone.

Osteopathic Manipulative Treatment for Optic Pathway Glioma

Abstract Optic gliomas are a known complication of neurofibromatosis type 1 (NF1) and can result in significant impairment. This case report centers around a 3-year-old girl with NF1 and optic glioma diagnosed by MRI, whose optic glioma has not increased in size since commencing treatment with osteopathic manipulative treatment (OMT) at regular intervals. We cover the rationale behind treating these patients with OMT with a thorough review of the relevant anatomy. We suggest a basis of treatment that could benefit patients with a number of intracranial and extracranial pathologies.

Can Serial Internal Optic Nerve Sheath Diameters Measured with Ultrasonography Predict the Prognosis of Medical Intensive Care Patients?

Aim: Optic nerve sheath (ONS) contains subarachnoid space, pia mater layer, and optic nerve fiber layer. ONS diamater (ONSD) without subarachnoid space is known as internal ONSD (iONSD). There are too many astrocytes and vascular network in iONSD area. Astrocytes are known to swell with systemic infection, inflammation, pro-inflammatory cytokines, some metabolic disorders, and oxidative stress. Also, this vascular network can vary by many ICU pathologies. This study investigated the relationship between serial iONSD measured with USG and the prognosis of critically ill patients who had no intracranial pathologies.
 Material and method: The mean iONSD values for the right eye (RiONSD) and left eye (LiONSD) were measured. MiONSD (the mean of RiONSD and LiONSD) and DiONSD (the difference of final and admission MiONSD of ICU stay) were calculated. 
 Results: 35 ICU patients without intracranial pathologies were included. There was a significant difference between survivors and non-survivors for DiONSD (-0.35 [(-0.85)-(-0.10)], 0.60 [(0.21)-(1.00)] mm respectively, p=0.0001). The multivariate analysis performed between DiONSD, SOFA, and APACHE II score (p=0.033, OR=10.66 %95 CI [1.21-93.92]) indicated that DiONSD was an independent risk factor for mortality. DiONSD values greater than + 0.25 mm was determined to be a predictor of mortality with 75% sensitivity and 95% specificity (LR=14.25, AUC=0.905, p=0.0001). There was a good corelation between DiONSD values and SOFA score, total fluid balance, sepsis, serum albumin level, and GCS level. 
 Conclusion: iONSD measurement with USG can be used to determine the prognosis of ICU patients who have no intracranial acute or chronic pathologies.

Clinical features, etiological reasons, and treatment results in patients who developed acute acquired nonaccomodative esotropia.

To evaluate the clinical features, possible etiological reasons, and treatment results in children who developed acute acquired comitant esotropia (AACE) without strabismus in previous years. Medical records of the patients who were diagnosed with AACE between July 2017 and June 2021 were retrospectively reviewed. The children with ocular and orbital pathology, hypermetropia > 2.00 diopters, and anisometropia > 1.00 diopters were not included in the study. Possible etiological factors that could cause esotropia, treatment results, motor, and sensory functions were investigated. The mean age at first admission, and the onset of AACE, was 8.8 ± 2.9 (4-13) years of three female (23.1%) and 10 male (76.9%) cases. The causes of AACE were determined to be occlusion of the eye due to corneal foreign body removal in one (7.7%), emotional stress in one case (7.7%), and excessive close work, on computer and smartphone screens in the other 11 cases (84.6%). Orthotropia was achieved in cases who underwent strabismus surgery (n = 10) and in cases using the prism (n = 2); except for one case, all (92.3%) achieved binocular single vision (100s/arc stereopsis and fusion) after treatment, while there was no binocular single vision in any of the cases before treatment. Acute acquired comitant esotropia is a rare clinical entity. Successful motor and sensory outcomes can be achieved by strabismus surgery or by prism therapy. It is critical to investigate the patientş with AACE in terms of intracranial pathologies, although rarely seen.

Prevalence of idiopathic epilepsy and structural epilepsy in 74 Boxer dogs in a referral hospital.

The prevalence of idiopathic epilepsy and structural epilepsy in Boxer dogs is unknown. The aim of this retrospective study was to evaluate the prevalence of structural and idiopathic epilepsy in the Boxer population. A total of 74 Boxer dogs were included in the study from the database of one referral hospital and the following were recorded: signalment, history, clinical findings and results of advanced diagnostic imaging. Five dogs (6.8%) were diagnosed with idiopathic epilepsy, of which one was in the <6 months age group, three were in the 6–72 months age group and one was in the >72 months age group. Sixty-nine dogs (93.2%) were diagnosed with structural epilepsy. Sixty-six had a suspected intracranial neoplasia: Eight were in the 6–72 months age group and represent 66.7% of the dogs in that age group. The other fifty-eight were in the >72 months age group and represent 96.7% of the dogs in that age group. In our Boxer population, 81.8% of the patients had a suspected intra-axial tumor and 22.7% of dogs with an intracranial pathology nevertheless had a normal neurological examination. In conclusion, in the majority of boxer patients the cause of epilepsy is a suspected intracranial neoplasia regardless of the age at presentation. Considering the finding in this study of a low prevalence of presumed idiopathic epilepsy in the Boxer breed, it is recommended that patients who satisfy Tier I confidence level of the “International Veterinary Epilepsy Task Force” (IVETF) also undergo an MRI study of the brain.

26 Case Report of a Pseudoaneurysm from Distal Anastomosis of Open AAA 32 Years Previously, Contained Within Original Aortic Sac

Abstract An 86-year-old gentleman attended hospital with confusion following collapse at home. On examination the abdomen was soft, non-tender and distended with an expansile mass. He underwent elective open repair of a 7cm AAA 32 years prior to current presentation. His past medical history included severe aortic stenosis and atrial fibrillation for which he was anticoagulated with warfarin. CT imaging of head for intracranial pathology. Triple phase contrast CT studies to assess possible aortic pathology. CT brain excluded intracranial pathology as cause of collapse. CT triple phase aortogram demonstrated an 8.4cm infrarenal abdominal aortic aneurysm. Arterial phased images show contrast in the previous aortic repair, however delayed images showed extravasation of contrast from a potential leak at the distal suture line, with blood filling the original aortic sac, outside the aortic surgical graft. No retroperitoneal leak was identified. This presentation was amenable to relining of the aorta with an EVAR however given the patient was asymptomatic and had significant comorbidities, no further intervention was undertaken. The patient and family agreed with this plan of action, and the patient died 3 weeks later. The duration of this contained leak was unknown.

An increased potential for organ donors may be found among patients with out-of-hospital cardiac arrest

IntroductionA prehospital system where obvious futile cases may be terminated prehospitally by physicians may reduce unethical treatment of dying patients. Withholding treatment in futile cases may seem ethically sound but may keep dying patients from becoming organ donors. The objective of this study was to characterise the prehospital patients who underwent organ donation. The aim was to alert prehospital physicians to a potential for an increase in the organ donor pool by considering continued treatment even in some prehospital patients with obvious fatal lesions or illness.MethodsThis is a retrospective register-based study from the Region of Southern Denmark. The prehospital medical records from patients who underwent organ donation after prehospital care from 1st of January 2016–31st of December 2020 were screened for inclusion. The outcome measures were prehospital diagnosis, vital parameters, and critical interventions.ResultsIn the five year period, one-hundred-and-fifty-one patients were entered into a donation process in the health region following prehospital care. Sixteen patients were excluded due to limitations in data availability. Of the 135 patients included, 36.3% had a stroke. 36.7% of these patients were intubated prehospitally. 15.6% had subarachnoideal haemorrhage. 66.7% of these were intubated prehospitally. 10.4% suffered from head trauma. 64.3% of these patients were intubated at the scene. In 21.5% of the patients, the prehospitally assigned tentative diagnosis was missing or included a diverse spectrum of medical and surgical emergencies. Twenty-two patients (16.3%) were resuscitated from cardiac arrest. 81.8% were intubated at the scene.ConclusionThe majority of the patients who became organ donors presented prehospitally with intracranial pathology. However, 30% of the patients that later underwent an organ donation process had other prehospital diagnoses. Among these, one patient in six had out-of-hospital cardiac arrest. Termination of treatment in patients with cardiac arrest is not uncommon in physician-manned prehospital emergency medical systems. An organ donation process cannot be initiated prehospitally but can be shut down if treatment is withheld or terminated. We contend that there is a potential for enlarging the donor pool if the decision processes in out-of-hospital cardiac arrest include considerations concerning future procurement of organ donors.

Optimizing Quality of Life and Minimizing Morbidity through Nasal Preservation in Endoscopic Skull Base Surgery: A Contemporary Review.

Introduction Endoscopic endonasal approaches (EEAs) are increasingly utilized for intracranial pathology. As opposed to sinonasal tumors, the nasal cavity is being used as a corridor to access these intracranial tumors but is not the site of primary surgical intent. Accordingly, there has been recent interest in preserving intranasal structures not directly involved by tumor and improving postoperative sinonasal quality of life (QOL). Objectives The aim of the study is to highlight recent advances in EEA techniques focused on improving sinonasal QOL including turbinate preservation, reducing the morbidity of reconstructive techniques, and the development of alternative minimally invasive EEA corridors. Methods The method of the study involves contemporary literature review and summary of implications for clinical practice. Results Nasoseptal flap (NSF) harvest is associated with significant morbidity including septal perforation, prolonged nasal crusting, and external nasal deformities. Various grafting and local rotational flaps have demonstrated the ability to significantly limit donor site morbidity. Free mucosal grafts have re-emerged as a reliable reconstructive option for sellar defects with an excellent sinonasal morbidity profile. Middle turbinate preservation is achievable in most EEA cases and has not been shown to cause postoperative obstructive sinusitis. Recently developed minimally invasive EEA techniques such as the superior ethmoidal approach have been described to better preserve intranasal structures while allowing intracranial access to resect skull base tumors and have shown promising sinonasal QOL results. Conclusion This contemporary review discusses balancing effective skull base reconstructive techniques with associated morbidity, the role of turbinate preservation in EEA, and the development of unique EEA techniques that allow for increased nasal structure preservation.

Clinical Profile, Neuroimaging Characteristics, and Surgical Outcomes of Patients With Acute Acquired Non-accommodative Comitant Esotropia.

To report the clinical presentations, neuroimaging findings, and surgical outcomes in patients with acute acquired non-accommodative comitant esotropia (AACE). A retrospective review of records of all patients diagnosed as having AACE between January 2011 and December 2019 across three tertiary eye care centers was done. Cases with AACE onset after age 1 year were included. Patients were divided into two groups based on age of onset of esotropia: childhood (16 years or younger) and adult (older than 16 years). Surgical success was defined as postoperative horizontal deviation of 8 prism diopters (PD) or less at the last follow-up visit. A total of 338 patients (220 males and 119 females; mean age at presentation: 12.60 ± 9.8 years) met the study criteria. The mean age at onset of esotropia in the childhood and adult onset groups was 3.61 ± 1.1 and 26.6 ± 8.7 years, respectively. There were significantly more individuals with myopia (30%) in the adult onset group compared to the childhood onset group (6%) (P = .004). Thirty-seven (16%) had positive neuroimaging findings (16.4% adult onset vs 9.4% childhood onset). A total of 148 (44%) patients underwent surgery for esotropia, and the overall success rate was 73%. Mean preoperative esotropia was comparable in either group (P = .20), but surgical success was better in the adult onset group (75.6% vs 66.3% in the childhood onset group). Mean duration of follow-up postoperatively was 13.6 ± 12 months. Two-thirds of the patients had childhood onset of AACE. Intracranial pathology was found in 1 of 6 patients. Surgical success was better in the adult onset group, which was not influenced by preoperative esotropia, neuroimaging findings, or refractive status, but was dependent on age at onset of esotropia and duration between onset and intervention. [J Pediatr Ophthalmol Strabismus. 2023;60(3):218-225.].

The Central Sulcus of the Insula: A Highly Reliable Radiographic Landmark for Identification of the Rolandic Sulcus

Anatomic studies have suggested that the central insular sulcus (CIS) runs in line with the Rolandic sulcus (RS). The radiographic relationship between the RS and CIS has not been systematically studied. This study aims to evaluate the applicability of using the CIS as a radiologic landmark to identify the RS. We retrospectively reviewed 100 consecutive normal magnetic resonance imaging (MRI) scans (200 hemispheres) performed at a single institution. MRI scans with any intracranial pathology or finding were excluded. Sagittal and axial fluid-attenuated inversion recovery sequences were used in this study. Two evaluators independently evaluated the relationship of the CIS and RS in all MRI scans. A predefined 3-step method was then used to identify the CIS, RS, and hand motor area in sagittal and axial images. The CIS was found to be correlated with the RS in 191 hemispheres (95.5%). In the remaining 9 hemispheres, the postcentral sulcus represented the most correlated sulcus with the CIS (7 hemispheres). The interrater agreement was 0.673 (P < 0.05), indicating a substantial agreement. The hand motor area was identified in the same section as the CIS in 175 hemispheres (87.5%). The CIS is a highly reliable radiographic landmark for the identification of the RS. The hand motor area can also be identified reliably using this method.

Brain topography on adult ultrasound images: Techniques, interpretation, and image library.

Many studies have explored the possibility of using cranial ultrasound for discerning intracranial pathologies like tumors, hemorrhagic stroke, or subdural hemorrhage in clinical scenarios where computer tomography may not be accessible or feasible. The visualization of intracranial anatomy on B-mode ultrasound is challenging due to the presence of the skull that limits insonation to a few segments on the temporal bone that are thin enough to allow transcranial transmission of sound. Several artifacts are produced by hyperechoic signals inherent in brain and skull anatomy when images are created using temporal windows. While the literature has investigated the accuracy of diagnosis of intracranial pathology with ultrasound, we lack a reference source for images acquired on cranial topography on B-mode ultrasound to illustrate the appearance of normal and abnormal structures of the brain and skull. Two investigators underwent hands-on training in Cranial point-of-care ultrasound (c-POCUS) and acquired multiple images from each patient to obtain the most in-depth images of brain to investigate all visible anatomical structures and pathology within 24hours of any CT/MRI imaging done. Most reproducible structures visible on c-POCUS included bony parts and parenchymal structures. Transcranial and abdominal presets were equivalent in elucidating anatomical structures. Brain pathology like parenchymal hemorrhage, cerebral edema, and hydrocephalus were also visualized. We present an illustrated anatomical atlas of cranial ultrasound B-mode images acquired in various pathologies in a critical care environment and compare our findings with published literature by performing a scoping review of literature on the subject.

Deep learning model to identify homonymous defects on automated perimetry

BackgroundHomonymous visual field (VF) defects are usually an indicator of serious intracranial pathology but may be subtle and difficult to detect. Artificial intelligence (AI) models could play a key role...

The Utility of Vessel Wall Imaging in the Postulation of Acute Ischemic Stroke With Spontaneous Recanalization Pathophysiology

:Recent advances in technology, particularly in the field of magnetic resonance imaging, have brought forth new sequences, including vessel wall imaging (VWI). Traditionally, the workup for intracranial vascular pathology has always turned to luminal imaging using computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography. Since its introduction, VWI has enabled researchers and practicing clinicians to better understand disease processes and manage patients to the best standard of care possible. Spontaneous recanalization in acute ischemic stroke (AIS) is a known but understudied phenomenon. Available literature has looked at this phenomenon and postulated the occurrence based on conventional cross-sectional imaging and angiography; however, objective evidence pointing to the occurrence of this phenomenon is scarce. We would like to share our experience using VWI in a patient who was clinically suspected to have a middle cerebral artery syndrome at onset, with resolution of the symptoms 3 hours after initial presentation. VWI showed vessel wall enhancement at the suspected vessel involved, with evidence of acute infarcts at the vascular territory supplied. A presumptive diagnosis of AIS with spontaneous recanalization was made. Our experience could potentially aid in the understanding of spontaneous recanalization in patients with AIS, particularly in the postulation of the pathophysiology.

Neonatal neurosonography practices: a survey of active Society for Pediatric Radiology members.

While neonatal brain US is emerging as an imaging modality with greater portability, widespread availability and relative lower cost compared to MRI, it is unknown whether US is being maximized in infants to increase sensitivity in detecting intracranial pathology related to common indications such as hemorrhage, ischemia and ventriculomegaly. To survey active members of the Society for Pediatric Radiology (SPR) regarding their utilization of various cranial US techniques and reporting practices in neonates. We distributed an online 10-question survey to SPR members to assess practice patterns of neonatal cranial US including protocol details, use of additional sonographic views, perceived utility of spectral Doppler evaluation, and germinal matrix hemorrhage and ventricular size reporting preferences. Of the 107 institutions represented, 90% of respondents were split evenly between free-standing children's hospitals and pediatric departments attached to a general hospital. We found that most used template reporting (72/107, 67%). The anterior fontanelle approach was standard practice (107/107, 100%). We found that posterior fontanelle views (72% sometimes, rarely or never) and high-frequency linear probes to evaluate far-field structures (52% sometimes, rarely or never) were seldom used. Results revealed a range of ways to report germinal matrix hemorrhage and measure ventricular indices to assess ventricular dilatation. There was substantial intra-institutional protocol and reporting variability as well. Our results demonstrate high variability in neurosonography practice and reporting among active SPR members, aside from the anterior fontanelle views, template reporting and linear high-resolution near-field evaluation. Standardization of reporting germinal matrix hemorrhage and ventricular size would help ensure a more consistent application of neonatal US in research and clinical practice.

Gradient Recall Echo and Susceptibility-Weighted Imaging: Interpretative Approach and Contribution to the Differential Diagnosis of Intracranial Pathology

Gradient Recall Echo and Susceptibility-Weighted Imaging: Interpretative Approach and Contribution to the Differential Diagnosis of Intracranial Pathology

Gradient Recall Echo and Susceptibility-Weighted Imaging: Interpretative Approach and Contribution to the Differential Diagnosis of Intracranial Pathology

Dr. Hobohm is Resident Physician, and Dr. Morales is Assistant Professor of Radiology, Section of Neuroradiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267; E-mail: [email protected]. All authors, faculty, and staff have no relevant financial relationship with any ineligible organizations regarding this educational activity. This article was published originally in Contemporary Diagnostic Radiology 2017;40(16):1-8. Category: Cerebrovascular, Tumor Lippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on July 14, 2025.

Evaluation of the etiological and clinical characteristics of pediatric central diabetes insipidus.

Central diabetes insipidus (CDI) is a rare but important disease of varying etiology that poses challenges in diagnosis and follow-up. Identifying diagnostic difficulties in patients with CDI will help ensure an optimal approach to their management and follow-up. This study aimed to characterize the clinical and etiological characteristics of CDI in pediatric patients. We analyzed the admission and follow-up data of CDI patients aged 0-18years who were followed in our center between 2010 and 2019. The study included 56 patients with a mean age at diagnosis of 7.92± 5.11years and symptom duration of 8.65± 21.3months. The patients were grouped by etiology into those with organic causes, such as structural anomalies, tumors, and trauma (group 1, n=41) and other causes (group 2, n=15). The prevalence of idiopathic CDI was 16%. At least one pituitary hormone deficiency was detected in 60.7%, the most common being thyroid stimulating hormone deficiency. Patients in group 1 had a higher mean age at diagnosis, shorter symptom duration, and higher frequency of other pituitary hormone deficiencies compared to group 2. Additionally, germinoma was detected 1 year subsequent to normal MRI findings at diagnosis and another patient was diagnosed with Langerhans cell histiocytosis (LCH) 5years after diagnosis. All patients responded well to replacement therapies, but two patients with germinoma died during follow-up. In the pediatric age group, intracranial organic pathologies are an important etiology of CDI, and despite a short symptomatic period, determining the cause may be challenging and prolonged. Patients presenting at a young age with a long history of symptoms and no other pituitary hormone deficiency are unlikely to have organic CDI. However, organic causes such as LCH should be evaluated at all ages. Patients with idiopathic disease are candidates for further etiological studies, and repeated cranial imaging is important during follow-up.