Ten-year-old male, who in 2001, suddenly suffered from severe headache associated with vomiting and refractory to ibuprofen.
Fundus examination revealed an incipient right papilledema.
A CT scan showed a right parasagittal occipital haemorrhage.
Subsequently, angiographic studies were performed, finding two malformative nests, one on the medial side of the right temporal lobe, 7.5 cc volume, and the other more posterior, located in the right occipital lobe MAc.
Neurological examination revealed a left hemianopsia with no other findings.
The examination of the eye fundus, already away from the acute episode of bleeding, was normal in both eyes.
Between 2001 and 2005, the child underwent surgery with selective embolization of the two malformative components, reducing the blood flow of the AVM and their size.
Radiosurgery was then performed with Gamma Knife.
The patient has not suffered recurrence of bleeding but has symptomatic seizures photosensory in medical treatment with valproic acid.
Its electroencephalographic study shows interspherical and exeptated regions of the right cerebral hemisphere, compatible with right parieto-occipital structural brain involvement where sporadic epileptic anomalies have been observed.
Currently, there has been an increase in the pharmacological dose of its medical treatment due to exacerbation of the seizures and goes to our department due to a non-epileptic drug evolution, which has been attributed to an intermittent diplopia of four months.
In the exploration, the patient has VA of 0.6 (OD) and 0.5 (OI).
Pupillary reflexes are normal.
Presents orthophoria, with dummy and normal versions.
The Cover Test showed an exophoria of -3o -5o near and -5o -7o far.
The eye fundus of both eyes is apparently normal.
The refractive defect showed myopia of -0.75 diopters in both eyes.
A campimetric study (Humphrey, threshold test 24-2 respect) was carried out with a left inferior hemianópsychosensory defect highly conductive in both eyes, and a greater density of defect in the left hemisphere.
Optical correction is prescribed to the patient in order to improve their visual acuity and control their foria.
