A 15-year-old teenager with refractory intracranial hypertension due to scalp arteriovenous fistula: case report.

Background: Refractory intracranial hypertension is a condition characterized by persistently elevated intracranial pressure that does not respond to conventional treatments. Diagnosis and management typically involve a combination of medical and surgical interventions. However, identifying the potential etiology can be particularly difficult under certain conditions. The causes of refractory intracranial hypertension due to non-traumatic brain injury are often difficult to detect. Untreated or ineffectively treated refractory intracranial hypertension can result in severe symptoms and potential vision loss.

Case presentation: We reported a 15-year-old teenager with no history of trauma who experienced intermittent headaches and projectile vomiting over a 30-day period, accompanied by intracranial pressure exceeding 28 cmH₂O. Through clinical reasoning combined with auxiliary examinations, including angiography and ultrasonography, and confirmed by follow-ups after experimental therapy, a final diagnosis of scalp arteriovenous fistula was established.

Conclusions: This case highlights the importance of considering extracranial causes in cases of refractory intracranial hypertension and management strategy for patients with refractory intracranial hypertension.