A five-year-old boy referred by his primary care pediatrician for a study of right fronto-temporal fronto-temporal cranial deformity that had become more evident in recent months.
He had occasionally experienced vomiting with bad odors, of one year of evolution, and headache accompanied by sonophobia and mentalphobia, of variable frequency and mild intensity that had never awakened him in the evening since three years.
Neurological examination was normal (including eye fundus), except for macrocephalia with 55 cm of perimeter (> percentile 99).
The only significant family history is a left frontal QA operated on the paterno grandparent.
She was born from a controlled pregnancy, with normal prenatal ultrasound and normal delivery without complications.
She had no other relevant personal history.
Psychomotor development was normal, with free walking at 13 months of age, language and creativity appropriate to the age, and she is schooled with learning difficulties in writing skills.
Cranial CT shows a large QA in the right middle cranial fossa with displacement of the midline and collapse of the adjacent ventricular arrows, which is confirmed in the right post-stroke hyperintense region T2-weighted.
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The patient was referred to Neurosurgery where intracranial pressure was monitored with an epidural sensor called "neu", "precoronal frontal fixation", "pathological" only at night.
Chronic intracranial hypertension was diagnosed and treated with a cystourethrostomy. The QA was performed with an optical-carpal cistern. The patient informed a double balloon cyst and a catheter was placed in the CSF.
