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A 16-year-old boy with a headache, back neck pain and positional vertigo
  1. Martina Bevacqua1,
  2. Giuseppe Abbracciavento2,
  3. Flora Maria Murru2,
  4. Egidio Barbi1,2
  1. 1University of Trieste, Trieste, Italy
  2. 2Institute for Maternal and Child Health, Trieste, Italy
  1. Correspondence to Dr Martina Bevacqua, University of Trieste, Trieste, Italy; martinabevacqua91{at}gmail.com

https://doi.org/10.1136/archdischild-2019-316831

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    A 16-year-old boy was admitted for a few days’ history of mild headache, moderate to severe posterior neck and dorsal back pain, nausea, vomiting many times during the day, and subjective positional vertigo. There was no night awakening for pain, neither night or on awakening vomit. He had been treated with ibuprofen without benefit. His history was unremarkable.

    On admission, physical and neurological examinations were unremarkable except for thoracolumbar pain during the flexion-extension of the trunk and refusal to stay in the orthostatic (the upright posture) position. Systemic blood pressure was 100/65 mm Hg. An ear, nose and throat (ENT) examination was negative.

    A brain and spine MRI showed cerebral dural sinus congestion, with a widespread meningeal enhancement after administration of contrast (figure 1A,B).

    Figure 1

    (A) Sagittal postcontrast T1-weighted section. The arrow indicates the expansion of dural venous sinuses. (B) Coronal postcontrast T1-weighted image. The arrow shows the venous distension with pachymeningeal enhancement.

    Question 1

    Which is the most likely diagnosis?

    1. MRI evidence associated with cerebral spinal fluid (CSF) hypotension.

    2. Pseudotumour cerebri. …

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    Footnotes

    • Contributors MB and EB drafted the initial manuscript and approved the final manuscript as submitted. FMM and GA critically reviewed the manuscript and approved the final manuscript as submitted.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Patient consent for publication Obtained.