engleski

Transverse Sinus thrombosis Presenting as Pseudotumor Cerebri

Pseudotumor cerebri, also named idiopathic intracranial hypertension, is a condition of raised intracranial pressure in the absence of a mass lesion or cerebral edema (1-5). It is rare in chilhood and often associated with multiple clinical conditions (1, 6, 7). here we present a 6-year-old boy admitted with severe headache. At initial examination there were no visible neurological impairments and brain CT scan was normal. After 5 days the boy developed paresis of the left abducens nerve and edema of the optic nerve papilla. There were no changes in visus. MR with MR venography performed immediately showed signs of inflammation in the right cells with total occlusion of the right transverse sinus (fig 1). Cephalosporin antibiotic therapy was used in conservative treatment of mastoiditis. Several lumbar punctions were performed with CSF evacuation (lumbar CSF pressure was above 25 mmHg), with no clinical improvements. Severe, untreatable headaches with vomiting, still persistent abducens nerve palsy and edema of the optic nerve papilla (3 dpt) prompted our next treatment of elevated intracranial pressure-lumboperitoneal shunting. Before lumbar shunt insertion there were still signs of mastoiditis in regression and the child was under antibiotic therapy. after shunting all signs of elevated intracranial pressure resolved soon. Control MR with MR venography performed after 2 months showed normal venous outflow in all durall sinuses (fig 2). There were still some hyperdense zones in right mastoid cells. Sixth nerve palsy resolved completely, and vision was preserved.

pseudotumor cerebri; transverse sinus thrombosis

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