title: Outcome of pediatric patients referred for papilledema.
abstract: OBJECTIVE
  To determine the prevalence of papilledema versus pseudopapilledema among children referred for suspected papilledema and to identify clinical factors differentiating the two diagnoses.
  
  
  METHODS
  This is a prospective, cross-sectional analysis of patients <18 years old referred to a pediatric ophthalmology clinic for suspected papilledema by ophthalmoscopic examination between April 2012 and February 2014. Patients underwent detailed ophthalmologic and, when indicated, neurologic evaluation to determine the presence or absence of papilledema.
  
  
  RESULTS
  A total of 34 patients were identified. Of these, 26 patients were diagnosed with pseudopapilledema or a normal variant; 2, with papilledema; and 6, with unrelated or indeterminate etiology. Headache was a presenting symptom in 25 patients. Five patients complained of additional symptoms suggestive of increased intracranial pressure, of whom 2 were patients diagnosed with papilledema.
  
  
  CONCLUSIONS
  The incidence of true papilledema among children referred for suspected papilledema based on fundus examination is very low. Headache is a common nonspecific symptom in most patients, whether or not they have papilledema. If children have no additional signs and/or symptoms suggestive of elevated ICP or vision loss, the need for evaluation of such children is not urgent. A detailed history and examination coupled with noninvasive testing, such as ultrasonography, will generally distinguish pseudopapilledema from other abnormal-appearing optic nerves.
authors.affiliation: Nicklaus Children's Hospital, Miami Children's Health System, Miami, Florida.
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Kovarik
authors.affiliation: Scott and White Healthcare, Temple, Texas.
authors.forename: Poonam N
authors.initials: PN
authors.lastname: Doshi
authors.affiliation: Dean McGee Eye Institute, University of Oklahoma School of Medicine, Oklahoma City, Oklahoma.
authors.forename: Janine E
authors.initials: JE
authors.lastname: Collinge
authors.affiliation: Eugene and Marilyn Glick Eye Institute, Indiana University Medical Center, Indianapolis, Indiana. Electronic address: dplager@iu.edu.
authors.forename: David A
authors.initials: DA
authors.lastname: Plager
mesh_terms: D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D015785:Eye Diseases, Hereditary / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006261:Headache / Q000175:diagnosis; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D019586:Intracranial Hypertension / Q000175:diagnosis; D007427:Intracranial Pressure; D007429:Intraocular Pressure; D008297:Male; D009901:Optic Nerve Diseases / Q000175:diagnosis* / Q000453:epidemiology; D010211:Papilledema / Q000175:diagnosis* / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012017:Referral and Consultation