Empty Sella and Unilateral Sixth Nerve Palsy in a Pediatric Patient with Idiopathic Intracranial Hypertension

Abstract

Purpose: We report the case of a child with idiopathic intracranial hypertension who presented with binocular papillary edema and monocular sixth cranial nerve palsy accompanied by empty sella syndrome evident on brain magnetic resonance imaging.Case summary: A 9-year-old, normal-weight male patient visited the emergency room complaining of headache and diplopia 4 days in duration. The alternative prism cover test revealed esotropia of 16 prism diopters and a -1 right lateral gaze limitation. A fundus examination revealed papilledema and peripapillary hemorrhages in both eyes, and a visual field examination an enlarged, physiological blind spot in the right eye. Brain magnetic resonance imaging revealed elevated cerebrospinal fluid pressure, an empty sella, and posterior scleral flattening. We diagnosed and treated idiopathic intracranial hypertension. After 4 months, the papilledema and peripapillary hemorrhages of both eyes resolved, and the right lateral gaze limitation improved. The empty sella improved on brain magnetic resonance imaging, and we noted no recurrence 8 months after treatment.Conclusions: If a child with suspected idiopathic intracranial hypertension visits a hospital, but it is difficult to perform a lumbar puncture, brain magnetic resonance imaging should be scheduled. If abnormalities are found, these help to determine the course of disease.