• general paediatrics
• imaging
• paediatric practice
• neurology

A 10-year-old boy arrived at the emergency department with intermittent diplopia, associated with mild frontal headache and right-sided tinnitus. The episodes of diplopia started 2 days earlier and were triggered by looking to the right. Twenty days prior to this, the child had an episode of right otalgia with serosanguineous otorrhoea, mild fever, dizziness and vomiting. A diagnosis of bullous myringitis was made. A 10-day treatment course of oral amoxicillin and corticosteroid was started with a rapid clinical and otoscopic improvement. On admission, the patient was in good clinical condition. On examination, no neurological abnormalities were found. Otoscopic examination showed a retracted tympanic membrane with middle ear effusion. Blood tests were unremarkable; with normal blood count, coagulation markers, negative C reactive protein (0.4 mg/dL) and erythrocyte sedimentation rate (3 mm/hour). On funduscopy, bilateral papilloedema was identified. This was more pronounced in the right eye. A brain MR was performed (figure 1). …