Research Journal of Medical Sciences
ISSN: Online 1993-6095ISSN: Print 1815-9346
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Abstract
A four month old boy was admitted with a fever and vomiting for 2 days duration. The child had a minor fall at home two days prior to hospital admission. On physical examination, he was febrile and irritable but consolable. Vital parameters were stable, Occipitofrontal circumference at admission was 42.5 cm (75 thcentile) with bulging and tense anterior fontanelle. The ophthalmologic evaluation was negative for papilledema or venous congestion. Neurological examination did not reveal cranial nerve involvement, sunset sign ,or pyramidal signs. There was no otitis media or focal signs of infection. Chest, cardiac and abdominal examinations were normal. Our patient had no history of recent vaccination, steroid, or Vitamin A ingestion. Clinical possibilities of acute meningitis, intracranial bleeding, obstructive hydrocephalus, and intracranial hypertension were considered. The child was evaluated along these lines, and urgent Cerebral ultrasounds followed by CT head were performed (Fig. 1 and 2). Neuroimaging revealed features of increased intracranial pressure, without intracranial bleeding, intracranial space-occupying lesion, or venous thrombosis. Blood investigations with sepsis markers were performed which showed Hemoglobin, total count and differential count, serum C- reactive protein, and procalcitonin were within normal range. The child had no evidence of sepsis in investigations. A lumbar puncture was performed, opening CSF pressure was 11 cm H2O (Normal value 5-7 cm H2O). CSF analysis was not suggestive of infection or inflammation. A clinical diagnosis of Intracranial Hypertension was made. The child was evaluated for metabolic and endocrine causes of raised intracranial pressure, investigations revealed normal serum calcium, serum electrolytes, thyroid profile, normal serum level of vitamin D 25-OH 36 mg mL‾1 (normal value >30 ng mL‾1) and serum Vitamin A level 0.40 µg mL‾1 (normal value 0.14-0.52 µg mL‾1).The child was empirically started on antibiotics, he was closely monitored for new symptoms and clinical deterioration; bulging anterior fontanelle and fever resolved within 48 hrs and his head circumference reduced from 42.5 cm to 41 cm. Antibiotics were stopped once blood and CSF cultures were sterile. The child was followed up at 4 weeks and 8 weeks after discharge, he remained asymptomatic.
How to cite this article:
R.A. Kadwa, Abraar Sheriff Mohammed, Wael Mohamed Abdel Aal, Sleeiman Alsihnawi, Alaa Saleh, Gihan Zina and Mohamed Laban. Benign Transient Intracranial Hypertension in an Infant Case Report .
DOI: https://doi.org/10.36478/10.59218/makrjms.2023.12.38.40
URL: https://www.makhillpublications.co/view-article/1815-9346/10.59218/makrjms.2023.12.38.40