A Case of Abducens Nerve Palsy and Disc Swelling Complicating Pregnancy-Induced Hypertension

Abstract

Purpose: Abducens nerve palsy complicating pre-eclampsia during pregnancy occurs very rarely. The authors describe right abducens nerve palsy, disc swelling, and hypertensive retinopathy found in both eyes of a pre-eclampsia patient. Case summary: A 29-year-old woman, who was in her 31st week of gestation, was admitted to the hospital complaining chiefly of diplopia and abduction limitation in her right eye, which started suddenly 3 weeks prior to admission. Her condition was carefully followed up by a local clinic because this symptom of hypertension manifested one month before her admission to the local clinic. Brain MRI and laboratory tests were performed in order to exclude diseases of the central nervous system and/or other systemic diseases. An alternative prism cover test showed approximately 25PD (prism diopter) right esotropia, with -2 degrees abduction limitation observed in the patient's right eye. Both hypertensive retinopathy and papilledema were observed. Her blood pressure was 155/110 mmHg, and she had moderate proteinuria when she was admitted to the hospital. She was referred to an obstetrician and diagnosed as having pre-eclampsia. Other than pre-eclampsia with proteinuria, the brain imaging examination failed to reveal any particular findings, such as CNS disorders, including brain edema, cerebral infarction, or a brain tumor. In addition, systemic diseases which might have caused papilledema and abducens nerve palsy, including diabetes mellitus, were not evident in this case. Therefore, the patient was diagnosed with ischemic abducens nerve palsy and hypertensive retinopathy complicating moderate pre-eclampsia. The patient’s diplopia and right eye abduction limitation were gradually relieved after parturition.