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Giant arachnoid granulation in a child with benign intracranial hypertension: an unusual case
Hyemin Park1, Gye Yeon Lim2, Tae-Hoon Eom1
1Catholic University of Korea, Yeouido Saint Mary's Hospital, 63-ro 10, Yeongdeungpo-gu, Seoul, South Korea.
Insights
A rare case of giant arachnoid granulation caused benign intracranial hypertension in a 6-year-old girl. Prompt diagnosis and acetazolamide treatment resolved her symptoms, highlighting this condition
Area of Science:
- Neurology
- Radiology
- Pediatrics
Background:
- Benign intracranial hypertension (BIH) can present with varied etiologies in children.
- Giant arachnoid granulations are rare anatomic variants that can mimic other intracranial pathologies.
- Understanding rare causes of BIH is crucial for accurate diagnosis and management.
Observation:
- A 6-year-old girl presented with diplopia and headache post-head injury.
- Ophthalmological examination revealed bilateral papilledema.
- Brain MRI demonstrated a lesion compressing the anterior superior sagittal sinus, consistent with giant arachnoid granulation.
Findings:
- The lesion showed characteristic signal intensities on T2WI and T1WI.
- Magnetic resonance venography indicated venous narrowing and altered cortical venous drainage.
- Lumbar puncture confirmed elevated opening pressure (30 mmHg) with normal cerebrospinal fluid analysis.
Implications:
- Giant arachnoid granulation is a rare cause of BIH in children.
- Accurate diagnosis via neuroimaging can prevent unnecessary invasive procedures.
- Medical management with acetazolamide effectively reduced symptoms in this pediatric case.
Case Presentation:
A 6-year-old girl complained of diplopia and headache over a 2-week period after sustaining a minor head injury. Her neurological examinations were normal, but visual examination identified bilateral papilledema. Magnetic resonance imaging of the brain revealed a protruding nodular lesion causing compression within the anterior superior sagittal sinus in the midline, showing high signal intensity on T2-weighted imaging (T2WI) and low signal intensity on T1WI, similar to that of cerebrospinal fluid. Enhanced T1WI showed irregular narrowing of the anterior superior sagittal sinus adjacent to this lesion. The cortical vein drained to the frontal pole of the arachnoid granulation lesion and into the superior sagittal sinus. No other parenchymal abnormality was noted. A lumbar puncture showed increased opening pressure (30 mmHg), and the laboratory findings were normal. Based on the imaging and clinical findings, benign intracranial venous hypertension with giant arachnoid granulation was diagnosed. The patient's symptoms were reduced satisfactorily following daily treatment with 750 mg acetazolamide.
Conclusion:
We report a case of giant arachnoid granulation involving the anterior superior sagittal sinus in a 6-year-old girl who presented with benign intracranial hypertension. Clinicians should be aware of this rare anatomic variant to avoid unnecessary invasive procedures or examinations in children with benign intracranial hypertension.
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