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[External and internal hydrocephalus caused by an arteriovenous malformation in an infant]
Insights
A rare infantile case of Benign Intracranial Hypertension was treated by excising an arteriovenous malformation. This surgery resolved hydrocephalus and pericerebral effusion, highlighting careful CT interpretation in infants.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Pediatric Neurosurgery
Background:
- Benign Intracranial Hypertension (BIH) in infants can present with complex imaging findings.
- Arteriovenous malformations (AVMs) are rare causes of increased intracranial pressure in pediatric populations.
- Accurate diagnosis is crucial to differentiate BIH from cerebral atrophy on imaging.
Observation:
- A 9-month-old infant presented with epileptic seizures and imaging findings of ventricular enlargement and pericerebral effusion.
- Cerebral CT-Scan revealed a left parieto-temporal arteriovenous malformation shunting blood from the middle cerebral artery to the lateral sinus.
- Fontanellar transducer recorded borderline intracranial pressure.
Findings:
- Surgical excision of the arteriovenous malformation was performed.
- The procedure confirmed the subarachnoid location of the pericerebral effusion.
- Post-operatively, gradual resolution of both internal and external hydrocephalus was observed, attributed to reduced venous sinus pressure.
Implications:
- This case illustrates an infantile form of Benign Intracranial Hypertension.
- It underscores the importance of cautious interpretation of CT scans in infants to avoid misdiagnosing brain atrophy.
- Successful AVM resection can effectively manage hydrocephalus secondary to venous sinus hypertension.
Abstract:
In a 9 month-old infant, who displayed an epileptic seizure, the Brain CT-Scan shows a ventricular enlargement and a bilateral pericerebral effusion, associated with a left parieto-temporal arterio-venous malformation. Angiogram reveals a small angioma shunting the blood flow from the left middle cerebral artery into the lateral sinus. Intracranial pressure, recorded with a fontanellar transducer, is borderline. The angioma is excised and the operation, during which the subarachnoid location of the pericerebral effusion is confirmed, is followed by gradual subsiding of the internal and external hydrocephalus, that was caused by enhancement of the pressure in the venous sinuses. This case belongs to an infantile form of Benign Intracranial Hypertension, in which CT-Scan has to be interpreted cautiously, to avoid the pitfall of a wrong diagnosis of brain atrophy.