Acute hydrocephalus due to impaired CSF resorption in Toscana virus meningoencephalitis

Toscana virus, a neurotropic infectious agent endemic to Mediterranean countries, classified in the sandfly fever virus group (genus Phlebovirus, family Bunyaviridae), is a frequent cause of aseptic meningitis and encephalitis in Italy.1 The disease usually has a favorable outcome, and reports of severe courses are rare.1,2 We present an unusual case of acute hydrocephalus as the initial symptom of Toscana virus meningoencephalitis. ### Case report. A 21-year-old student presented with a 36-hour history of progressive bifronto-temporal headaches, retroorbital pressure, fever, nausea, vomiting, and double vision due to bilateral sixth cranial nerve deficits. Eight days before presentation, he had returned from a 2-week camping trip to Umbria, Italy, where he had suffered multiple tick bites. The patient's past personal and travel history was otherwise unremarkable. Apart from bilateral abductor nerve deficits, neurologic examination was normal, in particular showing no signs …