A.M., is a 14 year old girl, who presented with an episode of fever and sore throat associated to supraorbital pulsatile migraine with phonophobia, nausea and vomiting. The headache, exacerbated by eye movements, got worse in the following days, requiring access to the Emergency Department: ophthalmological examination showed bilateral optic nerve edema with peripapillary hemorrhages (LE>RE). CTscan results were unremarkable so a lumbar puncture was performed, which was normal, but immediate improvement of headache was noted. VEP, ERG and MRI were all normal, confirming the hypothesis of benign intracranial hypertension. No evidence of endocrine dysfunction was identified. The blood virological test ruled out the main etiologic agents (1-2HSV, CMV, parvovirus B19, Adenovirus) and the search for other, uncommon, viruses are still in progress. An empirical therapy with i.v. corticosteroids and acetazolamide 15mg/kg/die was started and iv potassium for 4 days was given for drug-induced hypokalemia.The next ophtalmological check up after 6 days therapy showed complete recovery from the peripapillary hemorrhages and a partial reduction in edema of the papillae. After excluding a secondary etiology for intracranial hyper-tension a diagnosis of idiophatic pseudo-tumor cerebri was established. The girl was discharged in good condition with instructions to continue low dose oral steroids tapering down the dose before stopping it completely together with diuretics until the next clinical follow-up.
A possible etiology for intracranial hy-pertension in pediatric age
FEDERICO, GIOVANNI;SAGGESE, GIUSEPPE
2013-01-01
Abstract
A.M., is a 14 year old girl, who presented with an episode of fever and sore throat associated to supraorbital pulsatile migraine with phonophobia, nausea and vomiting. The headache, exacerbated by eye movements, got worse in the following days, requiring access to the Emergency Department: ophthalmological examination showed bilateral optic nerve edema with peripapillary hemorrhages (LE>RE). CTscan results were unremarkable so a lumbar puncture was performed, which was normal, but immediate improvement of headache was noted. VEP, ERG and MRI were all normal, confirming the hypothesis of benign intracranial hypertension. No evidence of endocrine dysfunction was identified. The blood virological test ruled out the main etiologic agents (1-2HSV, CMV, parvovirus B19, Adenovirus) and the search for other, uncommon, viruses are still in progress. An empirical therapy with i.v. corticosteroids and acetazolamide 15mg/kg/die was started and iv potassium for 4 days was given for drug-induced hypokalemia.The next ophtalmological check up after 6 days therapy showed complete recovery from the peripapillary hemorrhages and a partial reduction in edema of the papillae. After excluding a secondary etiology for intracranial hyper-tension a diagnosis of idiophatic pseudo-tumor cerebri was established. The girl was discharged in good condition with instructions to continue low dose oral steroids tapering down the dose before stopping it completely together with diuretics until the next clinical follow-up.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
