Pediatric Annals

Firm Rounds 

A 5-year-old Girl with Headache and Eye Pain

Robert Listernick, MD

Abstract

This 5-year-old girl was evaluated for headache and bilateral eye pain. Three weeks prior to admission, she developed intermittent tactile fevers without other symptoms. One week later, she developed bifrontal headache and bilateral ear pain. She was seen by her physician and given amoxicillin for acute otitis media. Several days prior to admission, her mother noticed lateral deviation of her left eye. She was taken to an outside hospital where computerized tomography (CT) of the head was normal.

Key Learning Points

  1. Children who lose vision gradually rarely have visual complaints.
  2. Pseudotumor cerebri, or idiopathic intracranial hypertension, is characterized by elevated cerebrospinal fluid (CSF) pressure and papilledema without hydrocephalus or abnormal CSF composition.
  3. Causes of PC include obesity, venous sinus thrombosis, corticosteroid therapy or withdrawal, and a variety of drugs including tetracycline, large doses of vitamin A, and oral contraceptives.
  4. Gradenigo syndrome, petrous apicitis, is a complication of direct extension of mastoiditis within the temporal bone into the air cells of the petrous apex. The clinical triad of Gradenigo syndrome is suppurative otitis media, unilateral sixth nerve palsy, and pain in the distribution of the trigeminal nerve.
  5. The microbiology of mastoiditis includes Streptococcus pneumoniae, non-typable Haemophilus influenzae, Branhamella catarrhalis, and Staphylococcus aureus.

ABOUT THE AUTHOR

Dr. Listernick is Professor of Pediatrics at Feinberg School of Medicine, Northwestern University, and Director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL.

Abstract

This 5-year-old girl was evaluated for headache and bilateral eye pain. Three weeks prior to admission, she developed intermittent tactile fevers without other symptoms. One week later, she developed bifrontal headache and bilateral ear pain. She was seen by her physician and given amoxicillin for acute otitis media. Several days prior to admission, her mother noticed lateral deviation of her left eye. She was taken to an outside hospital where computerized tomography (CT) of the head was normal.

Key Learning Points

  1. Children who lose vision gradually rarely have visual complaints.
  2. Pseudotumor cerebri, or idiopathic intracranial hypertension, is characterized by elevated cerebrospinal fluid (CSF) pressure and papilledema without hydrocephalus or abnormal CSF composition.
  3. Causes of PC include obesity, venous sinus thrombosis, corticosteroid therapy or withdrawal, and a variety of drugs including tetracycline, large doses of vitamin A, and oral contraceptives.
  4. Gradenigo syndrome, petrous apicitis, is a complication of direct extension of mastoiditis within the temporal bone into the air cells of the petrous apex. The clinical triad of Gradenigo syndrome is suppurative otitis media, unilateral sixth nerve palsy, and pain in the distribution of the trigeminal nerve.
  5. The microbiology of mastoiditis includes Streptococcus pneumoniae, non-typable Haemophilus influenzae, Branhamella catarrhalis, and Staphylococcus aureus.

ABOUT THE AUTHOR

Dr. Listernick is Professor of Pediatrics at Feinberg School of Medicine, Northwestern University, and Director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL.

This 5-year-old girl was evaluated for headache and bilateral eye pain. Three weeks prior to admission, she developed intermittent tactile fevers without other symptoms. One week later, she developed bifrontal headache and bilateral ear pain. She was seen by her physician and given amoxicillin for acute otitis media. Several days prior to admission, her mother noticed lateral deviation of her left eye. She was taken to an outside hospital where computerized tomography (CT) of the head was normal.

Key Learning Points

  1. Children who lose vision gradually rarely have visual complaints.
  2. Pseudotumor cerebri, or idiopathic intracranial hypertension, is characterized by elevated cerebrospinal fluid (CSF) pressure and papilledema without hydrocephalus or abnormal CSF composition.
  3. Causes of PC include obesity, venous sinus thrombosis, corticosteroid therapy or withdrawal, and a variety of drugs including tetracycline, large doses of vitamin A, and oral contraceptives.
  4. Gradenigo syndrome, petrous apicitis, is a complication of direct extension of mastoiditis within the temporal bone into the air cells of the petrous apex. The clinical triad of Gradenigo syndrome is suppurative otitis media, unilateral sixth nerve palsy, and pain in the distribution of the trigeminal nerve.
  5. The microbiology of mastoiditis includes Streptococcus pneumoniae, non-typable Haemophilus influenzae, Branhamella catarrhalis, and Staphylococcus aureus.

ABOUT THE AUTHOR

Dr. Listernick is Professor of Pediatrics at Feinberg School of Medicine, Northwestern University, and Director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL.

10.3928/00904481-20080101-04

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