Pediatric pseudotumor cerebri syndrome: Clinical characteristics, management and outcomes in a single-center cohort

Objective: Pediatric pseudotumor cerebri syndrome (PTCS) differs from adult disease in epidemiology, risk factors and clinical presentation. Female predominance and obesity are typically reported after puberty, while secondary forms are more frequent in younger children. Due to limited data on prepubertal patients, this study aimed to analyze clinical features, management and outcomes of pediatric PTCS, focusing on metabolic factors and disease course. Methods: We retrospectively analyzed 14 children and adolescents diagnosed with PTCS in a pediatric center between 2015 and 2025, according to Friedman criteria. Data included demographics, pubertal status, body mass index, presenting symptoms, secondary causes, treatments and outcomes over 12 months. Additional post-study follow-up was performed when available. Results: Female predominance was observed regardless of pubertal status. All patients were overweight or obese at diagnosis. Headache was the most frequent presenting symptom (85.7%), often accompanied by visual symptoms. Papilledema was present in all patients. Secondary PTCS occurred in three patients. Treatment included weight loss and acetazolamide in all patients. At 12 months, complete clinical and ophthalmologic remission was achieved in 64.3%. Recurrences occurred in three patients, both early and late: two required surgical interventions. Conclusion: PTCS should be suspected in overweight or obese children and adolescents presenting with persistent headache or visual symptoms, regardless of pubertal status. Early diagnosis, weight control and regular ophthalmologic monitoring are essential to reduce the risk of permanent visual impairment. Long-term follow-up is necessary, as relapses may occur beyond the first year after diagnosis. Prospective studies are warranted to confirm these findings.