Fever and Bulging Fontanelle Mimicking Meningitis in an Infant Diagnosed With Benign Intracranial Hypertension

Goldberg, Ethan M.

doi:10.1097/pec.0b013e31828a3a28

Cited by 8 publications

(3 citation statements)

References 5 publications

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“…In 2 patients, only single lumbar punctures were conducted, and no medication was administered. 26,39 In 2 other infants, who were on either oral or topical corticosteroids prior to presenting with idiopathic intracranial hypertension, treatment was the reintroduction and gradual reduction of steroids. 27,28…”

Section: Risk Factorsmentioning

confidence: 99%

Infantile Idiopathic Intracranial Hypertension: A Case Study and Review of the Literature

et al. 2019

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Idiopathic intracranial hypertension, or pseudotumor cerebri, is an increase in cerebrospinal fluid pressure of unknown etiology. It is mostly seen in adults, less frequently in adolescents, rarely in younger children. Only 5 infants meeting idiopathic intracranial hypertension criteria have been mentioned in the literature. We report a case of a previously healthy 9-month-old boy who presented with irritability, decreased appetite, and a bulging fontanelle. Computed tomography (CT) head imaging and cerebrospinal fluid studies revealed normal results. The patient’s symptoms transiently resolved after the initial lumbar puncture, but 11 days later, his fontanelle bulged again. A second lumbar puncture revealed an elevated opening pressure of 35 cmH2O and led to a diagnosis of idiopathic intracranial hypertension in accordance with the modified Dandy Criteria. Treatment with acetazolamide at a dose of 25 mg/kg/d was initiated and the patient remained symptom-free for 6 weeks, followed by another relapse. His acetazolamide dose was increased to 37 mg/kg/d, with no further relapses to date. A diagnosis of idiopathic intracranial hypertension is challenging in infants, because the patients cannot yet verbalize typical idiopathic intracranial hypertension–related symptoms such as positional headaches, diplopia, or pulsatile tinnitus. Furthermore, it is more difficult to assess papilledema in that age group. If undetected and untreated, idiopathic intracranial hypertension may result in permanent visual deficits. Little is known about idiopathic intracranial hypertension in infants, and age-specific treatment guidelines are lacking. We discuss this rare case of infantile idiopathic intracranial hypertension and provide a review of the literature, including an overview of disease characteristics and outcomes of idiopathic intracranial hypertension in this very young age group.

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Section: Risk Factorsmentioning

confidence: 99%

Infantile Idiopathic Intracranial Hypertension: A Case Study and Review of the Literature

et al. 2019

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“…Notably, Roseola infantum, caused by human herpesvirus 6 is a common etiology. Other etiologies such as otitis media and post-vaccination status have also been described [9][10][11][12][13][14][15]. In rare cases a specific etiology may not be found and may be considered idiopathic.…”

Section: Discussionmentioning

confidence: 99%

Covid-19 presenting as a bulging fontanelle

Schiff

Brennan

2021

The American Journal of Emergency Medicine

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The 2019 novel coronavirus disease has become a global pandemic that has struck the United States particularly hard. While it has disproportionately caused severe illness in the elderly and older adult population, many children have also been infected with the virus and some have become critically ill. It is important to recognize COVID-19 may present differently in children; specifically, those under twelve months of age. We report a case of COVID-19 infection in an infant characterized by a bulging anterior fontanelle without any additional symptoms.

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“…1 Transient intracranial hypertension has been reported to develop following human herpes virus 6 infection, diphtheria-tetanus-pertussis vaccination and vitamin A supplementation. 7,9,10 We could not study the changes in plasma cytokine levels. Temporary fontanel bulging has been reported to develop after measles vaccination, however measles infection-related transient intracranial hypertension has not been previously reported.…”

Section: Discussionmentioning

confidence: 99%

Bulging fontanel during a measles infection

Şahin¹,

Bayhan²,

Alan³

2020

Germs

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Introduction Causes of a bulging fontanel in children include viral/bacterial meningitis, encephalitis, hydrocephaly, intracranial bleeding, psedotumor cerebri and central nervous system tumors. A less well-known cause of acutely-developing fontanel bulging is transient intracranial hypertension. Case report A 7-month-old female was brought to our hospital with fever, cough, watery nasal secretion and bulging fontanel for the last 3 days. The cranial ultrasound examination and cerebrospinal fluid examinations were normal. The patient's irritability and fontanel bulging improved the day after admission but a maculopapular rash developed. The measles Ig M was positive. Measles PCR was positive from urine and nasopharyngeal swab samples. The signs of intracranial hypertension of the patient recovered completely the day after admission and did not recur during the follow-up. The patient was discharged on the 5 th day of admission. Discussion Transient intracranial hypertension is thought to result from a transient increase in the quantity of the circulating cerebrospinal fluid but the pathogenesis is not clear.Conclusions Based on this case, we report that transient intracranial hypertension could develop during a measles infection. Keywords Transient intracranial hypertension, measles, intracranial hypertension, fontanel bulging, fever, meningitis Introduction1Causes of a bulging fontanel in children include viral/bacterial meningitis, encephalitis, hydrocephaly, intracranial bleeding, psedotumor cerebri and central nervous system tumors. A less well-known cause of acutely-developing fontanel

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Fever and Bulging Fontanelle Mimicking Meningitis in an Infant Diagnosed With Benign Intracranial Hypertension

Cited by 8 publications

References 5 publications

Infantile Idiopathic Intracranial Hypertension: A Case Study and Review of the Literature

Infantile Idiopathic Intracranial Hypertension: A Case Study and Review of the Literature

Covid-19 presenting as a bulging fontanelle

Bulging fontanel during a measles infection

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