Case 38-2009 — A 16-Year-Old Boy with Paroxysmal Headaches and Visual Changes

A boy was first seen in the pediatric neurology clinic at 16 years of age because of paroxysmal headaches and visual changes. Physical and neurologic examinations were normal, and imaging studies showed no intracranial abnormalities. Headaches persisted despite a variety of therapies and during the next 4 years were associated with transient weakness, loss of consciousness, obtundation, and back pain. Intermittent optic-disk edema was noted. When the patient was 21 years old, lumbar puncture revealed an opening pressure of 25 cm of water; several hours later, symptoms of cauda equina syndrome developed. A diagnostic procedure was performed.