{"id":20569,"date":"2026-07-31T10:33:03","date_gmt":"2026-07-31T10:33:03","guid":{"rendered":"https:\/\/woncaeurope2026.org\/sessions\/persistent-headaches-when-obstructive-hydrocephalus-hides-in-plain-sight\/"},"modified":"2026-07-31T10:33:03","modified_gmt":"2026-07-31T10:33:03","slug":"persistent-headaches-when-obstructive-hydrocephalus-hides-in-plain-sight","status":"publish","type":"wsa_session","link":"https:\/\/woncaeurope2026.org\/fr\/sessions\/persistent-headaches-when-obstructive-hydrocephalus-hides-in-plain-sight\/","title":{"rendered":"Persistent Headaches: When Obstructive Hydrocephalus Hides in Plain Sight"},"content":{"rendered":"<p>Chronic headaches are a frequent presentation in general practice and are usually benign, but atypical or refractory forms may conceal a serious intracranial disorder. Diagnostic difficulty increases when initial investigations are non-contributive or when MRI is contraindicated. This case illustrates such a challenge: progressively worsening headaches with transient neurological symptoms ultimately revealing a periaqueductal tumor responsible for obstructive hydrocephalus.A 64-year-old man presented with two months of fluctuating but disabling fronto-occipital headaches, intermittently associated with visual blurring and right upper-limb myoclonus. Symptoms progressed to include nausea, vomiting, falls, and limb tremor. Initial laboratory work-up, ENT evaluation showing sphenoiditis (treated without effect), and three cerebral CT angiographies were non-contributive. MRI could not be performed due to a metallic mandibular foreign body. The onset of transient malaise and pseudo-epileptic episodes prompted an EEG, which was normal. Ongoing clinical deterioration led to a lumbar puncture (LP), which provided immediate relief, suggesting intracranial hypertension. Cerebrospinal fluid analysis revealed markedly elevated protein (6 g\/L), compatible with Froin\u2019s syndrome. This key finding prompted a meticulous re-evaluation of prior CT scans, revealing a small periaqueductal\u2013pineal lesion obstructing CSF flow. The patient underwent endoscopic ventriculocisternostomy, biopsy, and placement of a ventriculo-cardiac shunt. Histology confirmed an anaplastic diffuse grade III glioma, followed by radio-chemotherapy.This case is notable for its atypical presentation of obstructive hydrocephalus with fluctuating headaches, myoclonus, and pseudo-epileptic episodes. Diagnostic difficulty was compounded by non-contributive imaging and the impossibility of MRI. The LP,rarely central in chronic headache assessment,proved decisive by revealing Froin\u2019s syndrome.Atypical chronic headaches with neurological fluctuations require repeated clinical assessment and early specialist involvement. Lumbar puncture may be essential when headaches remain unexplained.Secondary headaches are challenging to diagnose when early investigations are normal. In this case, the combination of progressive headaches, transient neurological episodes, and immediate improvement after LP strongly pointed toward obstructive hydrocephalus. This case underscores the importance of revisiting radiological studies when clinical evolution is atypical, and highlights the diagnostic value of LP in selected situations.Refractory headaches with transient neurological signs should prompt suspicion of secondary causes, including obstructive hydrocephalus and periaqueductal tumors.<\/p>\n","protected":false},"template":"","class_list":["post-20569","wsa_session","type-wsa_session","status-publish","hentry","description-off"],"_links":{"self":[{"href":"https:\/\/woncaeurope2026.org\/fr\/wp-json\/wp\/v2\/wsa_session\/20569","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/woncaeurope2026.org\/fr\/wp-json\/wp\/v2\/wsa_session"}],"about":[{"href":"https:\/\/woncaeurope2026.org\/fr\/wp-json\/wp\/v2\/types\/wsa_session"}],"wp:attachment":[{"href":"https:\/\/woncaeurope2026.org\/fr\/wp-json\/wp\/v2\/media?parent=20569"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}