Transcript Abklärung der chronischen CK

Minimal diagnostic work up
Specific diagnostic work up
HISTORY
Brain imaging
Medication, including contraceptives?
Recent rapid weight gain?
Menstruational problems?
Current or recent infection?
Any chronic illness?
Type of seizure?
Exclude intracranial mass lesion,
malformation, ventriculomegaly.
Clinical examination
Overweight?
Fever? Signs of CNS-infection?
Focal neurological signs (suggestive for
IIH: sixth nerve palsy)?
Reduced level of consciousness?
High blood pressure?
Laboratory
Na, Ca, Mg, phosphate, blood gases,
BUN, glucose, AST, RBC, WBC, CRP,
T3, TSH
More comprehensive work-up is required
if secondary intracranial hypertension is
suspected (see right column)
Exclude sinus venous thrombosis by MRV
in every atypical case, poor treatment
response, relapse!
Lumbar puncture
Performed during the morning, in lateral
decubitus condition, calm child. Sedation
if required. Avoid ketamine and inhalitve
anaesthetics.
Check CSF opening pressure:
>20 cm H2O is abnormal
Check for: Cell count, protein, glucose.
Consider infectious work-up.
Consider repeated LP if presentation is
suggestive for IIH but pressure is within
normal limits, particularly in the young
child.
Associated or causative
Conditions
IMPORTANT NOTICE: Any prepubertal
child and male adolescent has to be
considered atypical and secundary
intracranial hypertension has to be
suspected.
Medical disorders: Addison’s disease;
Hypoparathyroidism; Hypo- and
hyperthyroidism; Vitamin D deficiency;
Chronic obstructive pulmonary
disease; Right heart failure with
pulmonary hypertension; Sleep
apnoea; Renal failure; severe iron
deficiency anaemia; Thrombophilia
(Antiphospholipid-Syndrome); PCOS,
SLE.
Medications: Tetracycline and related
compounds; Nitrofuratoin; Chinolone;
Vitamin A and related compounds;
Anabolic steroids; Corticosteroid
withdrawal following prolonged
administration (including inhalative
steroids); Growth hormone
administration in deficient patients;
Nalidixic acid, Lithium, Norplant_
levonorgestral implant system
Ophthalmology
Obstruction to venous drainage:
Cerebral venous sinus thrombosis;
Jugular vein thrombosis
Use age adjusted standardised visual field
testing.
Use Papilledema Grading System Scale.
Visus? Neuroophthalmology (VI palsy?).
(Post)infectious: Lyme-disease; postvaricella; ???