EP 75. Rare cause of bilateral seventh nerve palsy – Importance of optic nerve sonography before lumbar puncture

Abstract

A 23 year old female patient with normal body mass index was admitted because of right sided facial weakness. At least for 3 years she suffered continous headache bifrontal which required daily use of analgetics. Vision was described as blurred for minutes on a few days per month, no other symptoms were stated. Medical examination showed a bilateral seventh nerve palsy, symptoms in the left face were slight. There were no signs of inflammation neither on laboratory values nor clinically. Optic nerve sonography showed an elevated optic nerve sheath diameter and an elevated optical disc bilaterally. CSF opening pressure was elevated significantly (35 cm H 2 O). CSF analysis was normal concerning protein level and cell count. Thrombosis of cerebral veins and sinus was excluded by means of MRI. Despite a removal of only 5 ml CSF, facial palsy improved completely and headache was much better for some days. We diagnosed a idiopathic intracranial hypertension. Acetazolamide was prescribed but it was taken only for some days because of adverse effects. After 6 weeks she got a second CSF removal of 25 ml. The CSF opening pressure was 46 cm H 2 O. Optic nerve sonography was unchanged with papilledema. Since 8 month until now, there was no recurrent headache and no facial palsy. The findings of the optic nerve sonography lead us to take the CSF opening pressure which has influenced the clinical management. This resulted in a complete recovery of a long lasting headache history. Fig. 1 . Elevation of the optical disc (papilledema).