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Título

Challenges of Intracranial Hypertension

RESUMO

CASE REPORT: A 13 years old female, in December 2021, she started to have daily, moderate-intensity, tightening holocranial headache, lasting for hours and improved after the use of simple analgesics. And it was a headache without warning signs. With persistence of the headache, but with worsening intensity, the patient was admitted to the hospital on 02/19/2022, complaining of binocular diplopia, with worsening at side views. She presented new episodes of nausea and vomiting 7 days after admission. We found on the neurological examination: she had esotropia and limitation for abduction of the left eye; Fundoscopy: bilateral papilledema. Cerebrospinal Fluid (CSF): Opening pressure (OP) 58 cmH2O, erythrocytes 15/ cells 23 (Poly 10%; Mono 90%) / Glucose 48 / Proteins 25 / VDRL non-reactive / Gram absent / China ink negative. Culture for bacteria and fungi: No growth. PCR Herpes virus: negative. Capillary glucose: 110 mg/dL. Patient received Ceftriaxone 4g/day for 7 days, Topiramate 100 mg/day and Acetazolamide 500 mg/day for 12 days. Venous Angioresonance was performed: transversus sinus hypoplasia. After 12 days of hospitalization, patient was without diplopia with improvement of esotropia. A new CSF collect was performed: OP: 38 cmH2O, cells: 0, erythrocytes: 30, glucose 52. Capillary glucose: 115 mg/dL. DISCUSSION: Our patient had a syndromic diagnosis of Intracranial Hypertension (IH): she had a prolonged clinical picture with non-spontaneous clinical resolution (that needed topiramate and acetazolamide to resolve), in the context of an altered CSF. In fact, this was the main reason why our patient did not meet the criteria for Idiopathic IH. The patient presented criteria for aseptic meningitis (AM), with pleocytosis greater than four cells in CSF associated with a process free of contamination by fungi, bacteria or parasites. AM has as main etiologies: systemic diseases with meningeal involvement, induced by drugs, because of neoplasic and the most common, viral. FINAL COMMENTS: Therefore, our patient presented IH associated with CSF with characteristics of AM with a prolonged clinical picture. Due to the various etiologies of AM, diagnosis and treatment becomes a challenge, especially when associated with IH in a young patient with a severe impairment who arrives in the emergency room with CSF so altered. Please note the context of a public hospital with difficulties in identifying viral causes. for AM.

Palavras Chave

Headache; Aseptic meningitis; Intracranial hypertension.