Paediatric Unilateral Hydrocephalus an Unusual Presentation of Endovascular Proliferative Angiopathy of Unilateral Middle Cerebral Artery

Adolescent female 11years of age had gradual onset progressive weakness, involving left upper limb. There was no history of headache, vomiting or diminishing of vision, trauma and fever. Full term normal delivery child received vaccinations as per schedule. Neurologically normal till 4 years of her age when she had two generalised seizures with loss of consciousness. Clinical and brain CT examinations showed no abnormality. Electro-encephalography & routine cerebrospinal fluid studies were normal. Considered epileptic and was kept on oral medication with carbamazepine. Only a few case reports of isolated MCA angiopathy in their initial stages have been reported. Clinically, diminutive-neurocognitive functions of the child at different stages must always be co-related with angiography studies and followed-up at least every two years. Therapeutic window-period and the time lost, play important role in the overall management and clinical outcome.