A 10-Year Experiences in Pediatrics with Idiopathic Intracranial Hypertension: Prevalence of Preterm Birth, Delivery Methods, and the Correlation Between Preterm Birth and Delivery Type with the Development of Idiopathic Intracranial Hypertension

A 10-Year Experiences in Pediatrics with Idiopathic Intracranial Hypertension: Prevalence of Preterm Birth, Delivery Methods, and the Correlation Between Preterm Birth and Delivery Type with the Development of Idiopathic Intracranial Hypertension | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A 10-Year Experiences in Pediatrics with Idiopathic Intracranial Hypertension: Prevalence of Preterm Birth, Delivery Methods, and the Correlation Between Preterm Birth and Delivery Type with the Development of Idiopathic Intracranial Hypertension Mahmoud Reza Ashrafi, Mohammadsadegh Talebi Kahdouei, Reza Shervin Badv, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5735870/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Idiopathic intracranial hypertension (IIH) refers to a condition where intracranial pressure increases without an identifiable cause. If left untreated, it can become life-threatening. Identifying risk factors is crucial for timely intervention and follow-up care. This study aims to evaluate the prevalence of IIH in preterm children, investigate the type of delivery, and explore the relationship between delivery type, preterm birth, and increased intracranial pressure in these patients, with the goal of identifying potential risk factors for better management and follow-up. Methods: This retrospective study was approved by the Ethics Committee of Tehran Children's Medical Center and included patients diagnosed with IIH referred to the center from January 2014 to January 2024. Patient records were reviewed and categorized into four groups based on the revised Friedman criteria. Neuroimaging findings, assessed by a neuroradiologist, included empty sella, globe flattening, perioptic subarachnoid space distension, and transverse venous sinus stenosis. Demographic data, clinical symptoms, gestational age (preterm vs. term), and delivery type (NVD vs. cesarean section) were documented. Inclusion criteria required elevated lumbar CSF opening pressure with no other identifiable causes of intracranial hypertension. Written consent was obtained from all participants or their guardians. Results: In this study, 119 patients (mean age: 8.91 ± 4.26 years; 22.9% female) were examined, with an average BMI of 20.37 ± 6.06. Clinical symptoms included headaches (61.3%), nausea/vomiting (34.5%), diplopia (27.7%), and blurred vision (25.2%). Preterm births accounted for 37.81%. No significant correlations were found between CSF pressure and age, gender, BMI, symptoms, gestational age, or delivery type. Patients with papilledema were significantly older (10.05 vs. 8.40 years). Neuroimaging findings included transverse venous sinus stenosis (5.04%) and other abnormalities at low frequencies. Conclusion: This study found no significant association between the type of delivery or gestational age and the development of IIH. However, IIH prevalence was higher in patients born preterm or via cesarean section. The study suggests that reducing cesarean section and preterm birth rates could help lower IIH prevalence. Increasing natural deliveries and ensuring regular follow-ups for preterm infants may further reduce IIH incidence. Idiopathic intracranial hypertension preterm delivery type CSF Figures Figure 1 Figure 2 Introduction Idiopathic intracranial hypertension, which is essentially an increase in intracranial pressure without a known cause. [ 1 ]This condition predominantly affects females, particularly after puberty, and its diagnosis is especially challenging in children.[ 2 ] the most common presentation was headache, nausea, vomiting, blurred vision, double vision, and a range of other symptoms. For diagnosis, other causes of increased intracranial pressure must be ruled out, and the specific criteria for this condition must be met. The diagnostic criteria were first outlined by Dandy in 1937 and have since undergone several modifications, upon which this study is based.[ 3 ] To date, numerous studies have focused on the diagnosis, treatment, and epidemiology of this condition. However, there has been no examination of the prevalence of preterm births among these patients or the type of delivery methods employed. Additionally, the potential relationship between the type of delivery and preterm births with increased intracranial pressure has not been explored. This investigation is significant because, if a correlation between these two variables is found, it could lead to the implementation of periodic follow-ups for these patients, thereby preventing the morbidity/mortality associated with increased intracranial pressure in a proactive manner. The primary hypothesis of this study is to investigate the prevalence of idiopathic intracranial hypertension (IIH) in children and its potential association with the mode of delivery. Additionally, another hypothesis explored in this study is the prevalence of IIH in patients born preterm. It is hypothesized that the prevalence of IIH is higher among preterm-born patients, and this aspect has been thoroughly examined. The primary aim of this study is to investigate whether there is an association between the type of delivery and the occurrence of idiopathic intracranial hypertension (IIH) in children. Furthermore, the study examines whether the prevalence of IIH is related to the type of delivery. Lastly, it explores the prevalence of IIH based on the gestational age of the patients. Methods Study Design and Setting: The present study was conducted following the approval of the Ethics Committee of Tehran Children's Medical Center (IR.TUMS.MEDICINE.REC.1400.826). This retrospective study evaluated all patients diagnosed with IIH who were referred to the Tehran Children's Medical Center from January 2014 to January 2024. The electronic medical records of these patients were reviewed and categorized into four groups based on the revised Friedman criteria:[ 1 ] - Group A: Definitive IIH (OP ≥ 25, papilledema) - Group B: Probable IIH (OP < 25, papilledema) - Group C: Definite IIH-WOP (OP ≥ 25, abducens nerve palsy) - Group D: Suggested IIH- WOP (OP ≥ 25, ≥ 3 neuroimaging criteria) In neuroimaging assessments, four criteria were examined:[ 1 ] 1. Empty sella: is divided into five grades: - Grade 1: No herniation - Grade 2: Mild herniation ( 2/3 of the sella height) - Grade 5: Empty sella defined as enlarged sella turcica without observable pituitary parenchyma Grade of ≥ 3 is accepted as the cutoff for association with IIH. 2. Flattening of the posterior aspect of the globe (uni- or bilateral) 3. Distension of the perioptic subarachnoid space (uni- or bilateral), defined as > 2 mm distension in the coronal plane of T2-weighted images 4. Transverse venous sinus stenosis: Based on previous studies, this is divided into four grades: - Grade 1: ≤33% stenosis - Grade 2: 33–66% stenosis - Grade 3: ≥66% stenosis - Grade 4: Hypoplasia or agenesis All neuroimaging findings were reviewed by a skilled neuroradiologist. It's important to note the threshold for increased lumbar CSF opening pressure: 25 cm for patients with normal weight and non-sedated and 28 cm for obese or sedate patients (also for patients younger than 8year was ≥ 28 cm).[ 4 ] Patients meeting these criteria, with no obvious other etiology for increased intracranial pressure, were included in the study. Demographic data including age, gender, and body mass index (BMI) were recorded. Clinical symptoms at presentation, such as headache, blurred vision, diplopia, and nausea/vomiting, were also documented. Additionally, gestational age was noted, categorizing patients into preterm (less than 37 weeks) and term (37 weeks or more). Delivery type was recorded, dividing patients into NVD and cesarean section groups. Written consent was obtained from patients or their parents if under 16 years old. Data Analysis: Statistical analysis was performed using IBM SPSS version 27. The Kolmogorov-Smirnov test was used to assess the normality of the data distribution. Pearson correlation and independent t-tests were employed for parametric data analysis. Demographic data are presented as mean ± SD. Results In this study, a total of 119 patients were examined, with a mean age of 8.91 ± 4.26 years. Among these patients, 50 (22.9%) were female. The Body Mass Index of these patients was also assessed, with a mean BMI of 20.37 ± 6.06. The distribution of clinical symptoms was as follows: 73 patients (61.3%) had headaches, 41 patients (34.5%) had nausea and vomiting, 33 patients (27.7%) had diplopia, and 30 patients (25.2%) had blurred vision. Additionally, patients were divided into two categories based on gestational age: less than 37 weeks (37.81%) and 37 weeks or more (62.18%). According to the revised Friedman criteria, patients were classified into four groups: - Group A: Definite IIH (OP ≥ 25, papilledema) – 105 patients (88.23%) - Group B: Probable IIH (OP < 25, papilledema) – 7 patients (5.88%) - Group C: Definite IIH-WOP (OP ≥ 25, abducens nerve palsy) – 6 patients (5.04%) - Group D: Suggested IIH-WOP (OP ≥ 25, ≥ 3 neuroimaging criteria) – 1 patient (0.84%) A Pearson correlation test was used to examine the correlation between the age of the patients and the CSF pressure. No significant correlation was observed (p = 0.515, n = 119, r=-0.06). Similarly, no significant correlation was found between the gender of the patients and the CSF pressure (p = 0.904, n = 119, r=-0.11). A Pearson correlation test was also used to assess the relationship between the BMI of the patients and the CSF pressure, which also showed no significant correlation (p = 0.114, n = 119, r = 0.224). Furthermore, no significant correlations was found between the clinical symptoms (headache, nausea and vomiting, diplopia, and blurred vision) and the CSF pressure (p-value > 0.05). The Pearson correlation test also showed no significant relationship between the gestational age and the CSF pressure (p = 0.466, n = 119, r = 0.068) or between the type of delivery and the CSF pressure (p-value > 0.05).(table.1) Other variables were also examined for relationships. An independent t-test was used to assess the relationship between the age and gender of the patients, which showed no significant difference (p = 0.247, df = 88.24, t = 1.164). The mean age for females was 8.36 years and for males was 9.31 years. Similarly, no significant relationship was found between the gender and BMI of the patients (p = 0.075, df = 117, t = 1.194), with a mean BMI of 21.22 for males and 19.21 for females. An independent t-test showed a significant relationship between the gender and gestational age of the patients (p = 0.027, df = 52.35, t = 2.27), with a mean gestational age of 36.59 weeks for males and 35.71 weeks for females. Pearson correlation was used to assess the relationship between the age and other variables. The mean age of patients with headaches was 10.05 ± 2.95 years, and for those without headaches, it was 7.10 ± 5.31 years, showing a significant difference. However, no significant differences were found for nausea and vomiting (mean age 9.58 ± 3.52 years for those with and 8.56 ± 4.58 years for those without), diplopia (mean age 9.42 ± 4.24 years for those with and 8.72 ± 4.59 years for those without), and blurred vision (mean age 11.20 ± 2.24 years for those with and 8.14 ± 4.37 years for those without). No significant correlation was found between the age and gestational age (p = 0.959, n = 119, r=-0.005), or between the age and type of delivery (mean age 9.39 ± 4.32 years for cesarean delivery and 8.55 ± 4.20 years for NVD). BMI and clinical symptoms also showed no significant relationships: headache (mean BMI 20.36 ± 6.77 for those with and 20.40 ± 4.79 for those without), nausea and vomiting (mean BMI 20.38 ± 8.34 for those with and 20.37 ± 4.48 for those without), diplopia (mean BMI 20.83 ± 4.22 for those with and 20.20 ± 6.64 for those without), and blurred vision (mean BMI 22.87 ± 9.55 for those with and 19.53 ± 4.04 for those without). In the neuroimaging assessments, 2 patients (1.68%) had empty sella (based on the defined cutoff), 1 patient (0.84%) had flattening of the posterior aspect of the globe, 2 patients (1.68%) had distension of the perioptic subarachnoid space, and 6 patients (5.04%) had transverse venous sinus stenosis.(table.2) Based on the revised Friedman criteria, the distribution of patients in each group was: (table.3) - Group A: 105 patients (88.23%), with 81 preterm (77.14%) and 24 term (22.85%). In this group, 60 patients (57.14%) were born via cesarean section and 45 via natural delivery, with a mean CSF pressure of 44.44 ± 17.95. - Group B: 7 patients (5.88%), all preterm. In this group, 4 patients (57.14%) were born via cesarean section and 3 via natural delivery, with a mean CSF pressure of 13.57 ± 6.60. - Group C: 6 patients (5.04%), with 3 preterm (50%) and 3 term (50%). In this group, 2 patients (33.33%) were born via cesarean section and 4 via natural delivery, with a mean CSF pressure of 51.06 ± 16.40. - Group D: 1 patient (0.84%), who was preterm and born via natural delivery, with a mean CSF pressure of 35. N=119 p-value Age_ mean±SD 8.91±4.26 0.515 Gender_ No(%) Female Male 50(22.9) 69(31.7) 0.904 BMI_ mean±SD 20.37±6.06 0.114 Sign and Symptoms_ No(%) Headache Nausea and vomiting Diplopia Blurred vision 73(61.3) 41(34.5) 33(27.7) 30(25.2) 0.228 0.554 0.218 0.956 Gestational age_ mean(SD) <37 w _ No(%) ≥37 w _ No(%) 36.22 (1.84) 45(37.81) 74(62.18) 0.466 Delivery type Cesarean section_ No(%) NVD_ No(%) 51(42.9) 68(57.1) 0.809 L CSF op _ mean(SD) 38.47(15.46) Physical exam Papilledema_ No(%) Abducens nerve palsy_ No(%) Right Left 105(88.23) 10(8.4) 6(5.04) 4(3.36) Table 1. patient's characteristics Table 2 Neuroimaging criteria N = 119 No(%) Empty sella(grade ≥ 3) 2(1.68) Flattening of the posterior aspect of the globe(uni- or bilateral) 1(0.84) distension of the perioptic subarachnoid space( uni- or bilateral) 2(1.68) transverse venous sinus stenosis 6(5.04) Table 3 patients gestational age and delivery type prevalence N = 119 No(%) Gestational age Delivery type L csf op _ mean(SD) < 37 w ≥ 37 w cesarean NVD Group A 105(88.23) 81(77.14) 24(22.85) 60(57.14) 45(42.85) 44.44(17.95) Group B 7(5.88) 7(100) 0(0) 4(57.14) 3(42.85) 13.57(6.60) Group C 6(5.04) 3(50) 3(50) 2(33.33) 4(66.66) 51.06(16.40) Group D 1(0.84) 1(100) 0(0) 0(0) 1(100) 35 Discussion Since idiopathic intracranial hypertension (IIH) can be a potentially life-threatening condition, identifying its risk factors, preventive measures, and treatment approaches is of paramount importance. Recognizing these risk factors can aid in both preventing the development of IIH and ensuring appropriate treatment when it occurs.[ 5 ] In this context, the objective of our study is to assess the prevalence of IIH in preterm patients, as well as the relationship between IIH and delivery method (vaginal versus cesarean), in order to determine whether prematurity and mode of delivery can be considered risk factors for the development of IIH in the future. Although extensive research has been conducted on IIH and its associated risk factors, this study introduces a novel aspect by exploring whether preterm birth could be a contributing risk factor for the development of IIH. Additionally, it aims to assess the prevalence of IIH in preterm patients and evaluate the association between different delivery methods and the occurrence of IIH, specifically examining the prevalence of IIH across vaginal and cesarean deliveries. Initially, let us briefly review cerebrospinal fluid (CSF). Cerebrospinal fluid is derived from plasma within the blood vessels of the choroid plexus.[ 6 ] This process occurs as the plasma passes through the channels present in the apical and basal membranes, where it undergoes filtration and modification, ultimately forming CSF and its specific components. The choroid plexus serves as the primary site for CSF production, and through this selective transport mechanism, essential nutrients, ions, and other substances are transferred from the blood into the CSF, while waste products are removed from the central nervous system. This fluid then circulates, playing a vital role in protecting and maintaining the brain's and spinal cord's homeostasis.[ 6 ] According to previous studies, approximately 70% of cerebrospinal fluid (CSF) is produced by the choroid plexus, which is located within the brain's ventricles.[ 6 ] As shown in the figure below, the choroid plexus plays a key role in CSF production, where it facilitates the selective filtration of plasma, resulting in the formation of CSF.(figure-2) This study examines the prevalence of Idiopathic Intracranial Hypertension (IIH) in patients born preterm, considering the type of delivery, and investigates the correlation between the Lumbar CSF pressure with gestational age and the route of delivery. Next, we will examine and compare the findings of the current study with those of previous studies. In one study focusing on the epidemiological factors of this condition, the age range of affected patients was 4 to 7 years, whereas our findings indicate a broader age range of 4 to 12 years, This study also examined the gender of patients, revealing that the predominant gender varied across different age groups. In some age groups, males were more prevalent, while in others, females were more prevalent. However, our study found that males were predominantly affected, Another aspect of this study examined the BMI of patients, reporting an average BMI of 26.77 ± 6.62, similar to our findings of 20.37 ± 6.06.[ 4 ] Another study explored the prevalence of IIH concerning patients' gender and concluded that the condition was more common in females before puberty and in males after puberty, This finding contrasts with previous studies, which reported equal prevalence before puberty and higher prevalence in females after puberty, and also contradicts our findings, which show a higher prevalence in males overall.[ 7 ] In another study aimed at examining the demographic characteristics of IIH, contrary to our findings, a higher percentage of female patients was reported, with an average age of 11.92 ± 4.09, compared to our average of 8.91 ± 4.26, This discrepancy could be attributed to geographic and racial differences among the patients. [ 8 ] Regarding the symptoms of IIH, numerous studies have identified headache as the most common symptom, followed by nausea, vomiting, and diplopia, These findings are consistent with our study. [ 9 ] Another study similarly found headache to be the most prevalent symptom, but unlike our study, visual disturbances and reduced visual fields were more common after headaches, which contrasts with our findings. [ 10 ] One study reported headache as the most common symptom, followed by nausea, vomiting, and then diplopia, aligning with our results.[ 4 ] Few studies have addressed the sixth cranial nerve palsy in these patients. One review mentioned that only 14% of patients experienced this condition, which is consistent with our finding that a very small number of patients(8.4%) were affected.[ 11 ] Extensive research has also been conducted on the neuroimaging findings in IIH. Our study noted that only 1.68% of patients had an empty sella, 0.84% had flattening of the posterior aspect of the globe, 1.68% had distension of the perioptic subarachnoid space, and the most common finding was transverse venous sinus stenosis in 5.04% of patients. Other studies report varying neuroimaging findings, which can be attributed to anatomical differences, variations in CSF absorption mechanisms, and other factors.[ 7 ] A novel aspect of our study, not addressed in previous research, is the examination of IIH prevalence in preterm-born children and the relationship between preterm birth, the type of delivery, and opening CSF pressure. Our study concludes that while there is a high prevalence of preterm births and cesarean deliveries among these patients, there is no significant correlation with increased opening CSF pressure. Conclusion Based on the findings of this study, although no significant association was found between the type of delivery or gestational age and the development of idiopathic intracranial hypertension (IIH), the prevalence of IIH was higher in patients born preterm or delivered via cesarean section. The clinical implication highlighted in this study is that, given the higher prevalence of IIH in patients with a history of cesarean delivery and/or preterm birth, reducing the rates of cesarean sections and preterm births could play a role in decreasing the prevalence of IIH. Specifically, increasing the rate of natural deliveries among mothers may contribute to reducing the incidence of IIH in these children. Furthermore, in patients born preterm, implementing regular and periodic follow-ups to monitor for IIH symptoms could be effective in reducing its prevalence. However, it should be noted that this study has limitations that may introduce bias into the results. Thus, further extensive research is needed in the future to validate these findings. Limitation: Our report was cross sectional study that might cause a selection bias. Moreover, small number of subjects in our report implies further study with a larger sample size is necessary to clarify and confirm our findings. It should also be noted that this study was conducted as a single-center investigation, and there is a need to examine these patients in other centers as well. Abbreviations IIH: idiopathic intracranial hypertension BMI: body mass index WOP: without papilledema OP: opening pressure NVD: natural vaginal delivery Declarations Ethics approval and consent to participate This project was approved by the Ethics Committee of Tehran University of Medical Sciences (IR.TUMS.MEDICINE.REC.1400.826). Written informed consent was obtained from parents or legal guardian Consent for publication Written informed consent was obtained from parents Availability of data and materials Not applicable Competing interests The authors declare that they have no competing interests. Funding No fund Authors' contributions MR.A. and MS.TK. wrote the main manuscript and RS.B. and G.R.Z. and M.H. assisted in Conceptualization, Methodology and B.S. and F.A. and F.S.B. assisted in data collection and Z.R. and E.HM. drafted the work and revised it. Acknowledgements We thank all those who provided excellent assistance during the study Consent to Participate: All of these patients who visited the Tehran Children's Medical Center for participation in research projects have provided written consent for their involvement. References Korsbæk, J.J., et al., Diagnosis of idiopathic intracranial hypertension: A proposal for evidence-based diagnostic criteria. Cephalalgia, 2023. 43 (3): p. 3331024231152795. Lalou, A.D., et al., Cerebrospinal fluid dynamics in pediatric pseudotumor cerebri syndrome. Childs Nerv Syst, 2020. 36 (1): p. 73-86. Thaller, M., et al., The idiopathic intracranial hypertension prospective cohort study: evaluation of prognostic factors and outcomes. J Neurol, 2023. 270 (2): p. 851-863. Monteu, F., G. D'Alonzo, and R. Nuzzi, Pediatric Pseudotumor Cerebri: Epidemiological Features. The Open Ophthalmology Journal, 2020. 14 (1). Rangwala, L.M. and G.T. Liu, Pediatric idiopathic intracranial hypertension. Surv Ophthalmol, 2007. 52 (6): p. 597-617. Bonadio, W., Pediatric lumbar puncture and cerebrospinal fluid analysis. J Emerg Med, 2014. 46 (1): p. 141-50. Labella Álvarez, F., et al., Pseudotumor cerebri in the paediatric population: clinical features, treatment and prognosis. Neurologia (Engl Ed), 2024. 39 (2): p. 105-116. Bhalla, S., et al., Demographics, clinical features, and response to conventional treatments in pediatric Pseudotumor Cerebri syndrome: a single-center experience. Childs Nerv Syst, 2019. 35 (6): p. 991-998. Sager, G., et al., Evaluation of the signs and symptoms of pseudotumor cerebri syndrome in pediatric population. Childs Nerv Syst, 2021. 37 (10): p. 3067-3072. Yamamoto, E., et al., Assessment of Pediatric Pseudotumor Cerebri Clinical Characteristics and Outcomes. J Child Neurol, 2021. 36 (5): p. 341-349. Chen, B.S., N.J. Newman, and V. Biousse, Atypical presentations of idiopathic intracranial hypertension. Taiwan J Ophthalmol, 2021. 11 (1): p. 25-38. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5735870","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":397348816,"identity":"329706dd-d1c3-470c-a0b1-2de0943b8b6c","order_by":0,"name":"Mahmoud Reza Ashrafi","email":"","orcid":"","institution":"Pediatric Neurology Department, Children’s Medical Center, Pediatric Center of Excellent, Tehran University of Medical 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Rezaei","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYBAC+wYeBOdAQgWbHJjxAI8WRlQtZ/iMIQxitTAwtsklNoAY+LQws5899uEHwz05+fbDBw88OGOWPj/s8EOgLXZyug3YtbDx5CXP7GEoNmbsSUsA+iUtd+PtNAOglmRjswPYtfAw5BgDiYTEZoYcoMozx3I3zk4AaTmQuA2HFgn+N8aMfxgS6tv43384kNj2P91wdvoHvFoMJHKMmYG2JPBI5ACVtbElyEvn4LfFQOKNMbOMQYLhDIlnIIexGW6Qzik4kGCA2y/2/TnGjG8qEuTl+5Mff/xRwSYvPzt984cPFXZyuLRA7UJmH0AXIQjkG0hRPQpGwSgYBSMBAABgDmC2fqt6nwAAAABJRU5ErkJggg==","orcid":"","institution":"Pediatric Neurology Department, Children’s Medical Center, Pediatric Center of Excellent, Tehran University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Zahra","middleName":"","lastName":"Rezaei","suffix":""}],"badges":[],"createdAt":"2024-12-30 13:23:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5735870/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5735870/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":73087059,"identity":"8454b99f-366a-40ba-98f6-bdf64ee5ee3d","added_by":"auto","created_at":"2025-01-06 14:57:57","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":39826,"visible":true,"origin":"","legend":"\u003cp\u003eflowchart diagram\u003c/p\u003e","description":"","filename":"figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5735870/v1/f5608d67bb8436a68f98a256.jpg"},{"id":73087457,"identity":"2a0f819c-1607-4e86-91c8-7c2cd47ff971","added_by":"auto","created_at":"2025-01-06 15:05:57","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":55940,"visible":true,"origin":"","legend":"\u003cp\u003eCSF production and circulation pathway\u003c/p\u003e","description":"","filename":"figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5735870/v1/6da5ec8113567defc33340c6.jpg"},{"id":78325623,"identity":"1188584c-9240-40c1-a45f-7d3b10b5dabb","added_by":"auto","created_at":"2025-03-12 06:16:46","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":901716,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5735870/v1/31b72685-7e02-4c3d-a2be-b0e6b33937c4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A 10-Year Experiences in Pediatrics with Idiopathic Intracranial Hypertension: Prevalence of Preterm Birth, Delivery Methods, and the Correlation Between Preterm Birth and Delivery Type with the Development of Idiopathic Intracranial Hypertension","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIdiopathic intracranial hypertension, which is essentially an increase in intracranial pressure without a known cause. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]This condition predominantly affects females, particularly after puberty, and its diagnosis is especially challenging in children.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] the most common presentation was headache, nausea, vomiting, blurred vision, double vision, and a range of other symptoms. For diagnosis, other causes of increased intracranial pressure must be ruled out, and the specific criteria for this condition must be met. The diagnostic criteria were first outlined by Dandy in 1937 and have since undergone several modifications, upon which this study is based.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eTo date, numerous studies have focused on the diagnosis, treatment, and epidemiology of this condition. However, there has been no examination of the prevalence of preterm births among these patients or the type of delivery methods employed. Additionally, the potential relationship between the type of delivery and preterm births with increased intracranial pressure has not been explored.\u003c/p\u003e \u003cp\u003eThis investigation is significant because, if a correlation between these two variables is found, it could lead to the implementation of periodic follow-ups for these patients, thereby preventing the morbidity/mortality associated with increased intracranial pressure in a proactive manner.\u003c/p\u003e \u003cp\u003eThe primary hypothesis of this study is to investigate the prevalence of idiopathic intracranial hypertension (IIH) in children and its potential association with the mode of delivery. Additionally, another hypothesis explored in this study is the prevalence of IIH in patients born preterm. It is hypothesized that the prevalence of IIH is higher among preterm-born patients, and this aspect has been thoroughly examined.\u003c/p\u003e \u003cp\u003eThe primary aim of this study is to investigate whether there is an association between the type of delivery and the occurrence of idiopathic intracranial hypertension (IIH) in children. Furthermore, the study examines whether the prevalence of IIH is related to the type of delivery. Lastly, it explores the prevalence of IIH based on the gestational age of the patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy Design and Setting:\u003c/h2\u003e\n \u003cp\u003eThe present study was conducted following the approval of the Ethics Committee of Tehran Children\u0026apos;s Medical Center (IR.TUMS.MEDICINE.REC.1400.826). This retrospective study evaluated all patients diagnosed with IIH who were referred to the Tehran Children\u0026apos;s Medical Center from January 2014 to January 2024. The electronic medical records of these patients were reviewed and categorized into four groups based on the revised Friedman criteria:[\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e\n \u003cp\u003e- Group A: Definitive IIH (OP\u0026thinsp;\u0026ge;\u0026thinsp;25, papilledema)\u003c/p\u003e\n \u003cp\u003e- Group B: Probable IIH (OP\u0026thinsp;\u0026lt;\u0026thinsp;25, papilledema)\u003c/p\u003e\n \u003cp\u003e- Group C: Definite IIH-WOP (OP\u0026thinsp;\u0026ge;\u0026thinsp;25, abducens nerve palsy)\u003c/p\u003e\n \u003cp\u003e- Group D: Suggested IIH- WOP (OP\u0026thinsp;\u0026ge;\u0026thinsp;25, \u0026ge; 3 neuroimaging criteria)\u003c/p\u003e\n \u003cp\u003eIn neuroimaging assessments, four criteria were examined:[\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e1. Empty sella: is divided into five grades:\u003c/p\u003e\n \u003c/span\u003e\n \u003cp\u003e- Grade 1: No herniation\u003c/p\u003e\n \u003cp\u003e- Grade 2: Mild herniation (\u0026lt;\u0026thinsp;1/3 of the sella height)\u003c/p\u003e\n \u003cp\u003e- Grade 3: Moderate herniation (1/3\u0026ndash;2/3 of the sella height)\u003c/p\u003e\n \u003cp\u003e- Grade 4: Severe herniation (\u0026gt;\u0026thinsp;2/3 of the sella height)\u003c/p\u003e\n \u003cp\u003e- Grade 5: Empty sella defined as enlarged sella turcica without observable pituitary parenchyma\u003c/p\u003e\n \u003cp\u003eGrade of \u0026ge;\u0026thinsp;3 is accepted as the cutoff for association with IIH.\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003e2. Flattening of the posterior aspect of the globe (uni- or bilateral)\u003cbr\u003e\u003c/span\u003e \u003cspan\u003e3. Distension of the perioptic subarachnoid space (uni- or bilateral), defined as \u0026gt;\u0026thinsp;2 mm distension in the coronal plane of T2-weighted images\u003cbr\u003e\u003c/span\u003e \u003cspan\u003e4. Transverse venous sinus stenosis: Based on previous studies, this is divided into four grades:\u003cbr\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e- Grade 1: \u0026le;33% stenosis\u003c/p\u003e\n \u003cp\u003e- Grade 2: 33\u0026ndash;66% stenosis\u003c/p\u003e\n \u003cp\u003e- Grade 3: \u0026ge;66% stenosis\u003c/p\u003e\n \u003cp\u003e- Grade 4: Hypoplasia or agenesis\u003c/p\u003e\n \u003cp\u003eAll neuroimaging findings were reviewed by a skilled neuroradiologist. It\u0026apos;s important to note the threshold for increased lumbar CSF opening pressure: 25 cm for patients with normal weight and non-sedated and 28 cm for obese or sedate patients (also for patients younger than 8year was \u0026ge;\u0026thinsp;28 cm).[\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e] Patients meeting these criteria, with no obvious other etiology for increased intracranial pressure, were included in the study. Demographic data including age, gender, and body mass index (BMI) were recorded. Clinical symptoms at presentation, such as headache, blurred vision, diplopia, and nausea/vomiting, were also documented. Additionally, gestational age was noted, categorizing patients into preterm (less than 37 weeks) and term (37 weeks or more). Delivery type was recorded, dividing patients into NVD and cesarean section groups. Written consent was obtained from patients or their parents if under 16 years old.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eData Analysis:\u003c/h2\u003e\n \u003cp\u003eStatistical analysis was performed using IBM SPSS version 27. The Kolmogorov-Smirnov test was used to assess the normality of the data distribution. Pearson correlation and independent t-tests were employed for parametric data analysis. Demographic data are presented as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eIn this study, a total of 119 patients were examined, with a mean age of 8.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26 years. Among these patients, 50 (22.9%) were female. The Body Mass Index of these patients was also assessed, with a mean BMI of 20.37\u0026thinsp;\u0026plusmn;\u0026thinsp;6.06. The distribution of clinical symptoms was as follows: 73 patients (61.3%) had headaches, 41 patients (34.5%) had nausea and vomiting, 33 patients (27.7%) had diplopia, and 30 patients (25.2%) had blurred vision. Additionally, patients were divided into two categories based on gestational age: less than 37 weeks (37.81%) and 37 weeks or more (62.18%). According to the revised Friedman criteria, patients were classified into four groups:\u003c/p\u003e\n\u003cp\u003e- Group A: Definite IIH (OP\u0026thinsp;\u0026ge;\u0026thinsp;25, papilledema) \u0026ndash; 105 patients (88.23%)\u003c/p\u003e\n\u003cp\u003e- Group B: Probable IIH (OP\u0026thinsp;\u0026lt;\u0026thinsp;25, papilledema) \u0026ndash; 7 patients (5.88%)\u003c/p\u003e\n\u003cp\u003e- Group C: Definite IIH-WOP (OP\u0026thinsp;\u0026ge;\u0026thinsp;25, abducens nerve palsy) \u0026ndash; 6 patients (5.04%)\u003c/p\u003e\n\u003cp\u003e- Group D: Suggested IIH-WOP (OP\u0026thinsp;\u0026ge;\u0026thinsp;25, \u0026ge;\u0026thinsp;3 neuroimaging criteria) \u0026ndash; 1 patient (0.84%)\u003c/p\u003e\n\u003cp\u003eA Pearson correlation test was used to examine the correlation between the age of the patients and the CSF pressure. No significant correlation was observed (p\u0026thinsp;=\u0026thinsp;0.515, n\u0026thinsp;=\u0026thinsp;119, r=-0.06). Similarly, no significant correlation was found between the gender of the patients and the CSF pressure (p\u0026thinsp;=\u0026thinsp;0.904, n\u0026thinsp;=\u0026thinsp;119, r=-0.11). A Pearson correlation test was also used to assess the relationship between the BMI of the patients and the CSF pressure, which also showed no significant correlation (p\u0026thinsp;=\u0026thinsp;0.114, n\u0026thinsp;=\u0026thinsp;119, r\u0026thinsp;=\u0026thinsp;0.224). Furthermore, no significant correlations was found between the clinical symptoms (headache, nausea and vomiting, diplopia, and blurred vision) and the CSF pressure (p-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The Pearson correlation test also showed no significant relationship between the gestational age and the CSF pressure (p\u0026thinsp;=\u0026thinsp;0.466, n\u0026thinsp;=\u0026thinsp;119, r\u0026thinsp;=\u0026thinsp;0.068) or between the type of delivery and the CSF pressure (p-value\u0026thinsp;\u0026gt;\u0026thinsp;0.05).(table.1)\u003c/p\u003e\n\u003cp\u003eOther variables were also examined for relationships. An independent t-test was used to assess the relationship between the age and gender of the patients, which showed no significant difference (p\u0026thinsp;=\u0026thinsp;0.247, df\u0026thinsp;=\u0026thinsp;88.24, t\u0026thinsp;=\u0026thinsp;1.164). The mean age for females was 8.36 years and for males was 9.31 years. Similarly, no significant relationship was found between the gender and BMI of the patients (p\u0026thinsp;=\u0026thinsp;0.075, df\u0026thinsp;=\u0026thinsp;117, t\u0026thinsp;=\u0026thinsp;1.194), with a mean BMI of 21.22 for males and 19.21 for females.\u003c/p\u003e\n\u003cp\u003eAn independent t-test showed a significant relationship between the gender and gestational age of the patients (p\u0026thinsp;=\u0026thinsp;0.027, df\u0026thinsp;=\u0026thinsp;52.35, t\u0026thinsp;=\u0026thinsp;2.27), with a mean gestational age of 36.59 weeks for males and 35.71 weeks for females. Pearson correlation was used to assess the relationship between the age and other variables. The mean age of patients with headaches was 10.05\u0026thinsp;\u0026plusmn;\u0026thinsp;2.95 years, and for those without headaches, it was 7.10\u0026thinsp;\u0026plusmn;\u0026thinsp;5.31 years, showing a significant difference. However, no significant differences were found for nausea and vomiting (mean age 9.58\u0026thinsp;\u0026plusmn;\u0026thinsp;3.52 years for those with and 8.56\u0026thinsp;\u0026plusmn;\u0026thinsp;4.58 years for those without), diplopia (mean age 9.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.24 years for those with and 8.72\u0026thinsp;\u0026plusmn;\u0026thinsp;4.59 years for those without), and blurred vision (mean age 11.20\u0026thinsp;\u0026plusmn;\u0026thinsp;2.24 years for those with and 8.14\u0026thinsp;\u0026plusmn;\u0026thinsp;4.37 years for those without).\u003c/p\u003e\n\u003cp\u003eNo significant correlation was found between the age and gestational age (p\u0026thinsp;=\u0026thinsp;0.959, n\u0026thinsp;=\u0026thinsp;119, r=-0.005), or between the age and type of delivery (mean age 9.39\u0026thinsp;\u0026plusmn;\u0026thinsp;4.32 years for cesarean delivery and 8.55\u0026thinsp;\u0026plusmn;\u0026thinsp;4.20 years for NVD). BMI and clinical symptoms also showed no significant relationships: headache (mean BMI 20.36\u0026thinsp;\u0026plusmn;\u0026thinsp;6.77 for those with and 20.40\u0026thinsp;\u0026plusmn;\u0026thinsp;4.79 for those without), nausea and vomiting (mean BMI 20.38\u0026thinsp;\u0026plusmn;\u0026thinsp;8.34 for those with and 20.37\u0026thinsp;\u0026plusmn;\u0026thinsp;4.48 for those without), diplopia (mean BMI 20.83\u0026thinsp;\u0026plusmn;\u0026thinsp;4.22 for those with and 20.20\u0026thinsp;\u0026plusmn;\u0026thinsp;6.64 for those without), and blurred vision (mean BMI 22.87\u0026thinsp;\u0026plusmn;\u0026thinsp;9.55 for those with and 19.53\u0026thinsp;\u0026plusmn;\u0026thinsp;4.04 for those without).\u003c/p\u003e\n\u003cp\u003eIn the neuroimaging assessments, 2 patients (1.68%) had empty sella (based on the defined cutoff), 1 patient (0.84%) had flattening of the posterior aspect of the globe, 2 patients (1.68%) had distension of the perioptic subarachnoid space, and 6 patients (5.04%) had transverse venous sinus stenosis.(table.2)\u003c/p\u003e\n\u003cp\u003eBased on the revised Friedman criteria, the distribution of patients in each group was: (table.3)\u003c/p\u003e\n\u003cp\u003e- Group A: 105 patients (88.23%), with 81 preterm (77.14%) and 24 term (22.85%). In this group, 60 patients (57.14%) were born via cesarean section and 45 via natural delivery, with a mean CSF pressure of 44.44\u0026thinsp;\u0026plusmn;\u0026thinsp;17.95.\u003c/p\u003e\n\u003cp\u003e- Group B: 7 patients (5.88%), all preterm. In this group, 4 patients (57.14%) were born via cesarean section and 3 via natural delivery, with a mean CSF pressure of 13.57\u0026thinsp;\u0026plusmn;\u0026thinsp;6.60.\u003c/p\u003e\n\u003cp\u003e- Group C: 6 patients (5.04%), with 3 preterm (50%) and 3 term (50%). In this group, 2 patients (33.33%) were born via cesarean section and 4 via natural delivery, with a mean CSF pressure of 51.06\u0026thinsp;\u0026plusmn;\u0026thinsp;16.40.\u003c/p\u003e\n\u003cp\u003e- Group D: 1 patient (0.84%), who was preterm and born via natural delivery, with a mean CSF pressure of 35.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.3462%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=119\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.6859%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.9679%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.3462%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge_ mean\u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.6859%;\"\u003e\n \u003cp\u003e8.91\u0026plusmn;4.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.9679%;\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.3462%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender_ No(%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.6859%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e50(22.9)\u003c/p\u003e\n \u003cp\u003e69(31.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.9679%;\"\u003e\n \u003cp\u003e0.904\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.3462%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBMI_ mean\u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.6859%;\"\u003e\n \u003cp\u003e20.37\u0026plusmn;6.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.9679%;\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.3462%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSign and Symptoms_ No(%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eHeadache\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNausea and vomiting\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDiplopia\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBlurred vision\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.6859%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e73(61.3)\u003c/p\u003e\n \u003cp\u003e41(34.5)\u003c/p\u003e\n \u003cp\u003e33(27.7)\u003c/p\u003e\n \u003cp\u003e30(25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.9679%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.228\u003c/p\u003e\n \u003cp\u003e0.554\u003c/p\u003e\n \u003cp\u003e0.218\u003c/p\u003e\n \u003cp\u003e0.956\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.3462%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGestational age_ mean(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;37\u003csup\u003ew\u003c/sup\u003e_ No(%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;37\u003csup\u003ew\u003c/sup\u003e_ No(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.6859%;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e36.22\u003c/span\u003e(1.84)\u003c/p\u003e\n \u003cp\u003e45(37.81)\u003c/p\u003e\n \u003cp\u003e74(62.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.9679%;\"\u003e\n \u003cp\u003e0.466\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.3462%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDelivery type\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCesarean section_ No(%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNVD_ No(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.6859%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e51(42.9)\u003c/p\u003e\n \u003cp\u003e68(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.9679%;\"\u003e\n \u003cp\u003e0.809\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.3462%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eL\u003csub\u003eCSF\u0026nbsp;\u003c/sub\u003eop\u003c/strong\u003e_ \u003cstrong\u003emean(SD)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.6859%;\"\u003e\n \u003cp\u003e38.47(15.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.9679%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 41.3462%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhysical exam\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePapilledema_ No(%)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAbducens nerve palsy_ No(%)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eRight\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLeft\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 28.6859%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e105(88.23)\u003c/p\u003e\n \u003cp\u003e10(8.4)\u003c/p\u003e\n \u003cp\u003e6(5.04)\u003c/p\u003e\n \u003cp\u003e4(3.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29.9679%;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cspan dir=\"LTR\"\u003eTable 1. patient\u0026apos;s characteristics\u003c/span\u003e\u003c/p\u003e\n\u003cdiv\u003e\u003cbr\u003e\u003c/div\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eNeuroimaging criteria\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;119\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmpty sella(grade\u0026thinsp;\u0026ge;\u0026thinsp;3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2(1.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFlattening of the posterior aspect of the globe(uni- or bilateral)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003edistension of the perioptic subarachnoid space( uni- or bilateral)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2(1.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003etransverse venous sinus stenosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6(5.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003epatients gestational age and delivery type prevalence\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eN\u0026thinsp;=\u0026thinsp;119\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eNo(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGestational age\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eDelivery type\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eL \u003csub\u003ecsf op\u003c/sub\u003e_ mean(SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;37\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ew\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;\u0026thinsp;37\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ew\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ecesarean\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNVD\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup A\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e105(88.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81(77.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24(22.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60(57.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45(42.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.44(17.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup B\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7(5.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(57.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(42.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.57(6.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup C\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6(5.04)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(33.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(66.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.06(16.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup D\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1(0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1(100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eSince idiopathic intracranial hypertension (IIH) can be a potentially life-threatening condition, identifying its risk factors, preventive measures, and treatment approaches is of paramount importance. Recognizing these risk factors can aid in both preventing the development of IIH and ensuring appropriate treatment when it occurs.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] In this context, the objective of our study is to assess the prevalence of IIH in preterm patients, as well as the relationship between IIH and delivery method (vaginal versus cesarean), in order to determine whether prematurity and mode of delivery can be considered risk factors for the development of IIH in the future.\u003c/p\u003e \u003cp\u003eAlthough extensive research has been conducted on IIH and its associated risk factors, this study introduces a novel aspect by exploring whether preterm birth could be a contributing risk factor for the development of IIH. Additionally, it aims to assess the prevalence of IIH in preterm patients and evaluate the association between different delivery methods and the occurrence of IIH, specifically examining the prevalence of IIH across vaginal and cesarean deliveries.\u003c/p\u003e \u003cp\u003eInitially, let us briefly review cerebrospinal fluid (CSF). Cerebrospinal fluid is derived from plasma within the blood vessels of the choroid plexus.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] This process occurs as the plasma passes through the channels present in the apical and basal membranes, where it undergoes filtration and modification, ultimately forming CSF and its specific components. The choroid plexus serves as the primary site for CSF production, and through this selective transport mechanism, essential nutrients, ions, and other substances are transferred from the blood into the CSF, while waste products are removed from the central nervous system. This fluid then circulates, playing a vital role in protecting and maintaining the brain's and spinal cord's homeostasis.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAccording to previous studies, approximately 70% of cerebrospinal fluid (CSF) is produced by the choroid plexus, which is located within the brain's ventricles.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] As shown in the figure below, the choroid plexus plays a key role in CSF production, where it facilitates the selective filtration of plasma, resulting in the formation of CSF.(figure-2)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThis study examines the prevalence of Idiopathic Intracranial Hypertension (IIH) in patients born preterm, considering the type of delivery, and investigates the correlation between the Lumbar CSF pressure with gestational age and the route of delivery.\u003c/p\u003e \u003cp\u003eNext, we will examine and compare the findings of the current study with those of previous studies. In one study focusing on the epidemiological factors of this condition, the age range of affected patients was 4 to 7 years, whereas our findings indicate a broader age range of 4 to 12 years, This study also examined the gender of patients, revealing that the predominant gender varied across different age groups. In some age groups, males were more prevalent, while in others, females were more prevalent. However, our study found that males were predominantly affected, Another aspect of this study examined the BMI of patients, reporting an average BMI of 26.77\u0026thinsp;\u0026plusmn;\u0026thinsp;6.62, similar to our findings of 20.37\u0026thinsp;\u0026plusmn;\u0026thinsp;6.06.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAnother study explored the prevalence of IIH concerning patients' gender and concluded that the condition was more common in females before puberty and in males after puberty, This finding contrasts with previous studies, which reported equal prevalence before puberty and higher prevalence in females after puberty, and also contradicts our findings, which show a higher prevalence in males overall.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] In another study aimed at examining the demographic characteristics of IIH, contrary to our findings, a higher percentage of female patients was reported, with an average age of 11.92\u0026thinsp;\u0026plusmn;\u0026thinsp;4.09, compared to our average of 8.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26, This discrepancy could be attributed to geographic and racial differences among the patients. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eRegarding the symptoms of IIH, numerous studies have identified headache as the most common symptom, followed by nausea, vomiting, and diplopia, These findings are consistent with our study. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] Another study similarly found headache to be the most prevalent symptom, but unlike our study, visual disturbances and reduced visual fields were more common after headaches, which contrasts with our findings. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] One study reported headache as the most common symptom, followed by nausea, vomiting, and then diplopia, aligning with our results.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eFew studies have addressed the sixth cranial nerve palsy in these patients. One review mentioned that only 14% of patients experienced this condition, which is consistent with our finding that a very small number of patients(8.4%) were affected.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] Extensive research has also been conducted on the neuroimaging findings in IIH.\u003c/p\u003e \u003cp\u003eOur study noted that only 1.68% of patients had an empty sella, 0.84% had flattening of the posterior aspect of the globe, 1.68% had distension of the perioptic subarachnoid space, and the most common finding was transverse venous sinus stenosis in 5.04% of patients. Other studies report varying neuroimaging findings, which can be attributed to anatomical differences, variations in CSF absorption mechanisms, and other factors.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eA novel aspect of our study, not addressed in previous research, is the examination of IIH prevalence in preterm-born children and the relationship between preterm birth, the type of delivery, and opening CSF pressure. Our study concludes that while there is a high prevalence of preterm births and cesarean deliveries among these patients, there is no significant correlation with increased opening CSF pressure.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eBased on the findings of this study, although no significant association was found between the type of delivery or gestational age and the development of idiopathic intracranial hypertension (IIH), the prevalence of IIH was higher in patients born preterm or delivered via cesarean section.\u003c/p\u003e \u003cp\u003eThe clinical implication highlighted in this study is that, given the higher prevalence of IIH in patients with a history of cesarean delivery and/or preterm birth, reducing the rates of cesarean sections and preterm births could play a role in decreasing the prevalence of IIH. Specifically, increasing the rate of natural deliveries among mothers may contribute to reducing the incidence of IIH in these children. Furthermore, in patients born preterm, implementing regular and periodic follow-ups to monitor for IIH symptoms could be effective in reducing its prevalence.\u003c/p\u003e \u003cp\u003eHowever, it should be noted that this study has limitations that may introduce bias into the results. Thus, further extensive research is needed in the future to validate these findings.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLimitation:\u003c/h2\u003e \u003cp\u003eOur report was cross sectional study that might cause a selection bias. Moreover, small number of subjects in our report implies further study with a larger sample size is necessary to clarify and confirm our findings. It should also be noted that this study was conducted as a single-center investigation, and there is a need to examine these patients in other centers as well.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eIIH: idiopathic intracranial hypertension\u003c/p\u003e\n\u003cp\u003eBMI: body mass index\u003c/p\u003e\n\u003cp\u003eWOP: without papilledema\u003c/p\u003e\n\u003cp\u003eOP: opening pressure\u003c/p\u003e\n\u003cp\u003eNVD: natural vaginal delivery\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was approved by the Ethics Committee of Tehran University of Medical Sciences (IR.TUMS.MEDICINE.REC.1400.826).\u0026nbsp;Written informed consent was obtained from parents or legal guardian\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from parents\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo fund\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMR.A. and MS.TK. wrote the main manuscript and RS.B. and G.R.Z. and M.H. assisted in Conceptualization, Methodology and B.S. and F.A. and F.S.B. assisted in data collection and Z.R. and E.HM. drafted the work and revised it.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all those who provided excellent assistance during the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll of these patients who visited the Tehran Children\u0026apos;s Medical Center for participation in research projects have provided written consent for their involvement.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKorsb\u0026aelig;k, J.J., et al., \u003cem\u003eDiagnosis of idiopathic intracranial hypertension: A proposal for evidence-based diagnostic criteria.\u003c/em\u003e Cephalalgia, 2023. \u003cstrong\u003e43\u003c/strong\u003e(3): p. 3331024231152795.\u003c/li\u003e\n\u003cli\u003eLalou, A.D., et al., \u003cem\u003eCerebrospinal fluid dynamics in pediatric pseudotumor cerebri syndrome.\u003c/em\u003e Childs Nerv Syst, 2020. \u003cstrong\u003e36\u003c/strong\u003e(1): p. 73-86.\u003c/li\u003e\n\u003cli\u003eThaller, M., et al., \u003cem\u003eThe idiopathic intracranial hypertension prospective cohort study: evaluation of prognostic factors and outcomes.\u003c/em\u003e J Neurol, 2023. \u003cstrong\u003e270\u003c/strong\u003e(2): p. 851-863.\u003c/li\u003e\n\u003cli\u003eMonteu, F., G. D\u0026apos;Alonzo, and R. Nuzzi, \u003cem\u003ePediatric Pseudotumor Cerebri: Epidemiological Features.\u003c/em\u003e The Open Ophthalmology Journal, 2020. \u003cstrong\u003e14\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eRangwala, L.M. and G.T. Liu, \u003cem\u003ePediatric idiopathic intracranial hypertension.\u003c/em\u003e Surv Ophthalmol, 2007. \u003cstrong\u003e52\u003c/strong\u003e(6): p. 597-617.\u003c/li\u003e\n\u003cli\u003eBonadio, W., \u003cem\u003ePediatric lumbar puncture and cerebrospinal fluid analysis.\u003c/em\u003e J Emerg Med, 2014. \u003cstrong\u003e46\u003c/strong\u003e(1): p. 141-50.\u003c/li\u003e\n\u003cli\u003eLabella \u0026Aacute;lvarez, F., et al., \u003cem\u003ePseudotumor cerebri in the paediatric population: clinical features, treatment and prognosis.\u003c/em\u003e Neurologia (Engl Ed), 2024. \u003cstrong\u003e39\u003c/strong\u003e(2): p. 105-116.\u003c/li\u003e\n\u003cli\u003eBhalla, S., et al., \u003cem\u003eDemographics, clinical features, and response to conventional treatments in pediatric Pseudotumor Cerebri syndrome: a single-center experience.\u003c/em\u003e Childs Nerv Syst, 2019. \u003cstrong\u003e35\u003c/strong\u003e(6): p. 991-998.\u003c/li\u003e\n\u003cli\u003eSager, G., et al., \u003cem\u003eEvaluation of the signs and symptoms of pseudotumor cerebri syndrome in pediatric population.\u003c/em\u003e Childs Nerv Syst, 2021. \u003cstrong\u003e37\u003c/strong\u003e(10): p. 3067-3072.\u003c/li\u003e\n\u003cli\u003eYamamoto, E., et al., \u003cem\u003eAssessment of Pediatric Pseudotumor Cerebri Clinical Characteristics and Outcomes.\u003c/em\u003e J Child Neurol, 2021. \u003cstrong\u003e36\u003c/strong\u003e(5): p. 341-349.\u003c/li\u003e\n\u003cli\u003eChen, B.S., N.J. Newman, and V. Biousse, \u003cem\u003eAtypical presentations of idiopathic intracranial hypertension.\u003c/em\u003e Taiwan J Ophthalmol, 2021. \u003cstrong\u003e11\u003c/strong\u003e(1): p. 25-38.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Idiopathic, intracranial hypertension, preterm, delivery type, CSF","lastPublishedDoi":"10.21203/rs.3.rs-5735870/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5735870/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIdiopathic intracranial hypertension (IIH) refers to a condition where intracranial pressure increases without an identifiable cause. If left untreated, it can become life-threatening. Identifying risk factors is crucial for timely intervention and follow-up care. This study aims to evaluate the prevalence of IIH in preterm children, investigate the type of delivery, and explore the relationship between delivery type, preterm birth, and increased intracranial pressure in these patients, with the goal of identifying potential risk factors for better management and follow-up.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods:\u003c/b\u003e\u003c/p\u003e \u003cp\u003e This retrospective study was approved by the Ethics Committee of Tehran Children's Medical Center and included patients diagnosed with IIH referred to the center from January 2014 to January 2024. Patient records were reviewed and categorized into four groups based on the revised Friedman criteria. Neuroimaging findings, assessed by a neuroradiologist, included empty sella, globe flattening, perioptic subarachnoid space distension, and transverse venous sinus stenosis. Demographic data, clinical symptoms, gestational age (preterm vs. term), and delivery type (NVD vs. cesarean section) were documented. Inclusion criteria required elevated lumbar CSF opening pressure with no other identifiable causes of intracranial hypertension. Written consent was obtained from all participants or their guardians.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIn this study, 119 patients (mean age: 8.91\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26 years; 22.9% female) were examined, with an average BMI of 20.37\u0026thinsp;\u0026plusmn;\u0026thinsp;6.06. Clinical symptoms included headaches (61.3%), nausea/vomiting (34.5%), diplopia (27.7%), and blurred vision (25.2%). Preterm births accounted for 37.81%. No significant correlations were found between CSF pressure and age, gender, BMI, symptoms, gestational age, or delivery type. Patients with papilledema were significantly older (10.05 vs. 8.40 years). Neuroimaging findings included transverse venous sinus stenosis (5.04%) and other abnormalities at low frequencies.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis study found no significant association between the type of delivery or gestational age and the development of IIH. However, IIH prevalence was higher in patients born preterm or via cesarean section. The study suggests that reducing cesarean section and preterm birth rates could help lower IIH prevalence. Increasing natural deliveries and ensuring regular follow-ups for preterm infants may further reduce IIH incidence.\u003c/p\u003e","manuscriptTitle":"A 10-Year Experiences in Pediatrics with Idiopathic Intracranial Hypertension: Prevalence of Preterm Birth, Delivery Methods, and the Correlation Between Preterm Birth and Delivery Type with the Development of Idiopathic Intracranial Hypertension","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-06 14:57:52","doi":"10.21203/rs.3.rs-5735870/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f8eaf1a2-e2bd-4bd1-a009-557944282c01","owner":[],"postedDate":"January 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-12T06:08:38+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-06 14:57:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5735870","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5735870","identity":"rs-5735870","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}