Atypical presentation of Cavum Vergae

The cavum septum pellucidum (CSP) and cavum vergae (CV) are fluid-filled midline spaces between the leaflets of the septum pellucidum, considered normal variants of fetal brain development. CSP is present in nearly all preterm infants, ~85% of full-term newborns, and persists in ~12% of children aged 6 months to 16 years. It usually closes by 3-6 months of age. In adults, its prevalence ranges widely from 4% to 74%, depending on imaging modality and diagnostic criteria.

A 13-year-old boy presented with severe, throbbing headaches unresponsive to nonsteroidal anti-inflammatory drugs or acetaminophen. There were no neurological deficits or associated symptoms such as photophobia or vomiting. Imaging showed bilateral frontomaxillary sinusitis and, incidentally, a midline fluid-filled space consistent with a CV, without signs of mass effect or hydrocephalus. Magnetic resonance (MR) imaging and MR venography confirmed the finding and excluded vascular or space-occupying lesions. The neurological team determined the CV to be an incidental finding. Conservative treatment of sinusitis led to symptomatic improvement. No surgical intervention was required, and annual follow-up was advised.

This case highlights the importance of distinguishing normal anatomical variants such as CV from pathological findings in pediatric headache evaluation. Although persistent CSP or CV may occasionally be associated with neurological or psychiatric conditions, most are asymptomatic and benign. Accurate diagnosis through imaging and multidisciplinary input prevents unnecessary intervention. Patient reassurance and follow-up remain the cornerstone of management in incidental, asymptomatic cases.