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Unilateral Exophthalmos as the First Sign of Chronic Obstructive Hydrocephalus in a Pediatric Patient: A Case Report
Mirjana Raicevic1, Srdjan S Nikolovski1,2,3, Sandra Nedovic4
1Department of Neurosurgery, University Children's Hospital, Belgrade, SRB.
Insights
Congenital hydrocephalus can cause rare orbital complications like eye protrusion. Prompt treatment with a ventriculoperitoneal shunt resolved the symptoms, revealing an orbital roof defect.
Area of Science:
- Ophthalmology
- Pediatrics
- Neurology
Background:
- Congenital hydrocephalus, characterized by excessive cerebrospinal fluid accumulation, can lead to increased intracranial pressure.
- Orbital complications are infrequent but serious manifestations of hydrocephalus in pediatric patients.
Observation:
- A 13-year-old male presented with progressive right eyelid swelling and edema.
- Initial imaging revealed internal hydrocephalus and cerebral edema, followed by developing right eye proptosis.
- A right orbital roof defect was identified postoperatively.
Findings:
- The patient's unilateral proptosis and eyelid edema were attributed to chronic increased intracranial pressure and ventricular enlargement.
- Surgical intervention with a ventriculoperitoneal shunt led to the resolution of eyelid edema and repositioning of the eye bulb.
- The presence of an orbital roof defect was identified as a potential contributing factor to the orbital manifestation.
Implications:
- This case highlights that orbital signs, such as proptosis and eyelid edema, can be the initial presenting symptoms of non-traumatic obstructive hydrocephalus in children.
- Early recognition and management of hydrocephalus are crucial to prevent severe ocular complications.
- The findings underscore the importance of a comprehensive diagnostic approach in pediatric patients with unexplained orbital symptoms.
Abstract:
Orbital complications are rare manifestations of congenital hydrocephalus. We present a case of a child presenting with unilateral exophthalmos and palpebral edema as a result of a chronic increased intracranial pressure and severe enlargement of the ventricular system. The initial presentation in our 13-year-old male patient was progressive right eyelid swelling. Echo-sonography showed right eyelid edema while computed tomography revealed internal hydrocephalus and cerebral edema. In the later course, an enlarging right bulb protrusion occurred, which was repositioned immediately after placing a ventriculoperitoneal shunt. The right eyelid edema decreased in the week following the procedure. The postoperative status was confirmed by magnetic resonance imaging, which also showed a right orbital roof defect. The observed orbital roof defect was considered a cause of the eye bulb protrusion in this case and highlights the possibility of orbital signs as the first manifestations of non-traumatic obstructive hydrocephalus in children.
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