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Cerebral aqueduct stenosis presenting with limb pain
1Paediatrics, Royal Berkshire Hospital, Reading, UK.
Insights
Two children with hydrocephalus and aqueduct stenosis experienced back and limb pain, not typical headache. Surgical ventricular drainage rapidly resolved all symptoms, including enlarged heads and gait issues.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Medical Case Reports
Background:
- Hydrocephalus, a condition of excess cerebrospinal fluid, can cause increased intracranial pressure.
- Aqueduct stenosis, a blockage in the cerebral aqueduct, is a common cause of obstructive hydrocephalus in children.
- Classic symptoms of increased intracranial pressure include headache, vomiting, and papilledema.
Observation:
- Two pediatric patients presented with atypical symptoms of hydrocephalus and aqueduct stenosis, primarily experiencing back and limb pain.
- Neither child initially exhibited classic signs such as headache or vomiting.
- Enlarged heads, ataxic gait, and papilledema developed later in both cases.
Findings:
- The etiology of the reported pain in these cases remains uncertain.
- Similar pain symptoms have been observed in patients with benign intracranial hypertension.
- Spinal nerve root pouch distension is a potential contributing factor to the pain.
Implications:
- Prompt surgical intervention, specifically operative ventricular drainage, led to rapid and complete symptom resolution in both children.
- This case highlights the importance of considering hydrocephalus even with atypical presentations in pediatric patients.
- Early diagnosis and treatment of pediatric hydrocephalus are crucial for favorable outcomes and preventing long-term neurological deficits.
Abstract:
Two children are reported with hydrocephalus and aqueduct stenosis who presented with back and limb pains. Neither had the classic symptoms of headache and vomiting. The children had enlarged heads and later developed ataxic gait and papilloedema. The cause of the pains is uncertain but similar symptoms have been reported in subjects with benign intracranial hypertension and may relate to spinal nerve root pouch distension. Operative ventricular drainage resulted in rapid improvement of all symptoms in both children.