Download PDF
Journal of Pediatric Neurology 2015; 13(01): 031-034
DOI: 10.1055/s-0035-1555150
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Headache and Diplopia after Rapid Maxillary Expansion: A Clue to Underdiagnosed Pseudotumor Cerebri Syndrome?

Anna Claudia Romeo
1   Department of Pediatrics, University of Messina, Messina, Italy
,
Sara Manti
1   Department of Pediatrics, University of Messina, Messina, Italy
,
Giuseppe Romeo
2   Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
,
Giovanni Stroscio
3   Department of Radiology, University of Messina, Messina, Italy
,
Valeria Dipasquale
1   Department of Pediatrics, University of Messina, Messina, Italy
,
Antonino Costa
1   Department of Pediatrics, University of Messina, Messina, Italy
,
Dominique De Vivo
1   Department of Pediatrics, University of Messina, Messina, Italy
,
Rosa Morabito
3   Department of Radiology, University of Messina, Messina, Italy
,
Emanuele David
3   Department of Radiology, University of Messina, Messina, Italy
4   Department of Radiology, Anatomopathology and Oncology, Sapienza University of Rome, Italy
,
Salvatore Savasta
5   Department of Pediatrics, IRCSS Policlinico San Matteo, University of Pavia, Pavia, Italy
,
Francesca Granata
3   Department of Radiology, University of Messina, Messina, Italy
› Author Affiliations
Further Information

Publication History

17 November 2014

17 January 2015

Publication Date:
13 July 2015 (online)

   Permissions and Reprints

Abstract

Rapid maxillary expansion (RME) is an orthodontic procedure that separates the two maxillary bones at the mid palatine suture level. RME is commonly used in the pediatric age group to reduce and/or eliminate a transverse maxillary deficiency. At our institution we followed up an 11-year-old adolescent who was diagnosed with a class III malocclusion and was treated by RME with the combined use of expansion appliances (i.e., Hyrax) in addition to maxillary protraction devices (i.e., Delaire facemask). Three months after the start of treatment, he complained of headache and double vision, and was admitted to our hospital. A funduscopic examination revealed papilledema. Magnetic resonance imaging of the brain showed intraocular protrusion of the optic nerve head and enlarged perioptic subarachnoid space. Cerebrospinal fluid opening pressure during lumbar puncture was elevated (+370 mm H2O), confirming the diagnosis of the pseudotumor cerebri syndrome (PTCS). Removal of the maxillary expander and facemask led to the complete resolution of clinical symptoms in 1 week. The association of RME and PTCS-related manifestations was first reported by Timms in 1986, but, to the best of our knowledge, further cases have been not described in the medical literature. This overlooks PTCS as a potential RME-associated complication. We suggest that clinicians should carefully consider PTCS in all pediatric patients that complain of headache and/or visual disturbances during a treatment by RME. We also speculate on the possible changes of the cerebral venous circulation during RME, potentially leading to an impaired venous drainage that may cause increased intracranial pressure and PTCS.

Keywords

rapid maxillary expansion - idiopathic intracranial hypertension - pseudotumor cerebri syndrome - children - adolescents
 

  • References

  • 1 Salpietro V, Mankad K, Kinali M , et al. Pediatric idiopathic intracranial hypertension and the underlying endocrine-metabolic dysfunction: a pilot study. J Pediatr Endocrinol Metab 2014; 27 (1-2) 107-115
    PubMedGoogle Scholar
  • 2 Rogers DL. A review of pediatric idiopathic intracranial hypertension. Pediatr Clin North Am 2014; 61 (3) 579-590
    CrossrefPubMedGoogle Scholar
  • 3 Salpietro V, Chimenz R, Arrigo T, Ruggieri M. Pediatric idiopathic intracranial hypertension and extreme childhood obesity: a role for weight gain. J Pediatr 2013; 162 (5) 1084
    PubMedGoogle Scholar
  • 4 Salpietro V, Polizzi A, Di Rosa G , et al. Adrenal disorders and the paediatric brain: pathophysiological considerations and clinical implications. Int J Endocrinol 2014; 2014: 282489
    PubMedGoogle Scholar
  • 5 Salpietro V, Ruggieri M, Sancetta F , et al. New insights on the relationship between pseudotumor cerebri and secondary hyperaldosteronism in children. J Hypertens 2012; 30 (3) 629-630
    PubMedGoogle Scholar
  • 6 Salpietro V, Ruggieri M. Pseudotumor cerebri pathophysiology: the likely role of aldosterone. Headache 2014; 54 (7) 1229
    CrossrefPubMedGoogle Scholar
  • 7 Khan MU, Khalid H, Salpietro V, Weber KT. Idiopathic intracranial hypertension associated with either primary or secondary aldosteronism. Am J Med Sci 2013; 346 (3) 194-198
    CrossrefPubMedGoogle Scholar
  • 8 Salpietro V, Polizzi A, Bertè LF , et al. Idiopathic intracranial hypertension: a unifying neuroendocrine hypothesis through the adrenal-brain axis. Neuroendocrinol Lett 2012; 33 (6) 569-573
    PubMedGoogle Scholar
  • 9 Eichenberger M, Baumgartner S. The impact of rapid palatal expansion on children's general health: a literature review. Eur J Paediatr Dent 2014; 15 (1) 67-71
    PubMedGoogle Scholar
  • 10 Baccetti T, McGill JS, Franchi L, McNamara Jr JA, Tollaro I. Skeletal effects of early treatment of Class III malocclusion with maxillary expansion and face-mask therapy. Am J Orthod Dentofacial Orthop 1998; 113 (3) 333-343
    Google Scholar
  • 11 Lione R, Franchi L, Cozza P. Does rapid maxillary expansion induce adverse effects in growing subjects?. Angle Orthod 2013; 83 (1) 172-182
    CrossrefPubMedGoogle Scholar
  • 12 Li Q, Wang W, Zhang Q, Wang L. Changes in CT cerebral blood flow and volume associated with rapid maxillary expansion in a rabbit model. Angle Orthod 2012; 82 (3) 418-423
    CrossrefPubMedGoogle Scholar
  • 13 Holberg C. Effects of rapid maxillary expansion on the cranial base—an FEM-analysis. J Orofac Orthop 2005; 66 (1) 54-66
    CrossrefPubMedGoogle Scholar
  • 14 Timms DJ. Rapid Maxillary Expansion. Chicago, United States: Quintessence Publishing Co Incorporation; 1986
    Google Scholar