Cerebral aqueduct stenosis presenting with limb pain

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.