Abstract
Background: Double vision due to abducens nerve palsy in patients with Pseudotumor cerebri is a very rare finding and usually occurs by increasing in intracranial pressure (ICP) and therefore by the effect of pressure on abducens nerve. Case Report: A 21-year-old woman has referred to our clinic with symptoms of the headaches, double vision along with nausea and vomiting lasting for three months, with no history of the disease, drug consumption, and the only clinical findings was weighing about 20 Kg for a recent year. In examination VI nerve palsy of the left eye, papilledema of both eyes was reported. The computed tomography (CT) and magnetic resonance imaging (MRI) as a diagnostic test for a patient’s brain lesions shown normal report. Also, other hormone testing and complete blood count were normal. For the next step patient underwent for lumbar puncture (LP), the patient’s cerebrospinal fluid (CSF) pressure was measured more than 120 CmH2O. According to the findings of the examination, patient diagnosed with pseudotumor cerebri and underwent for frequent LP, which during that the headaches and double vision symptoms of patient decreased, which indicates that all signs and symptoms of patients caused by pseudotumor cerebri were due to sudden increase in body weight over the past year. Patient prescribed for Acetazolamide and recommended to lose weight with proper diet. For three months of follow-up, symptoms of increased ICP and papilledema have been cleared. Conclusion: The pseudotumor cerebri is manageable by proper diet, and there is no need for bariatric surgery. [GMJ.2017;6(1):66-69]
Highlights
Idiopathic intracranial pressure (ICP) increase, which causes a headache, papilledema, tinnitus and visual acuity reduction may lead to abducens nerve paralysis- which is very rare- and cause diplopia [1]
Idiopathic means there are no specific and determined causes for this syndrome but on the other hand it has been suggested that these causes act by increase in intracranial venous pressure which followed by [1] elevated venous pressure, which causes impairing in cerebrospinal fluid (CSF) absorption leads to increases in the resistance to outflow of CSF and marked increases in ICP [2]
Overweighting in a year caused an increase in abdominal pressure and by its effect caused increasing of ICP which were managed through proper diet and losing weight
Summary
Idiopathic intracranial pressure (ICP) increase, which causes a headache, papilledema, tinnitus and visual acuity reduction may lead to abducens nerve paralysis- which is very rare- and cause diplopia [1]. This report is the first case of abducent nerve palsy due to ti idiopathic ICP increase from Iran in the English medical literature. On physical examination of the patient, papilledema in eyes; left VI nerve palsy and decreased visual acuity in both eyes was evident.
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