Pseudothrombophlebitic onset of septic arthritis in a patient with systemic lupus erythematosus.

Abstract

Objective: To report a case of Idiopathic intracranial hypertension and Thiamine deficiency presenting with oculomotor dysfunction. Background: Idiopathic intracranial hypertension (IIH) presents with clinical signs and symptoms like headache, papilledema and vision loss. Transient visual obscurations occur in about 2/3rd of patients with papilledema. Intermittent or continuous horizontal diplopia due to 6th CN palsy is well known. Thiamine deficiency causes classical triad of Wernicke’s encephalopathy (WE)- ataxia, ophthalmoplegia and encephalopathy. Absence of one or more of the classic symptoms can leads to under diagnosis. Oculomotor manifestations of WE include nystagmus, lateral rectus palsy and conjugate gaze palsies. Design/Methods: Retrospective review of medical records. Results: A 23-year-old female presented to her primary care physician with headache, blurred vision and diplopia. She was found to have bilateral papilledema and bilateral 6th cranial nerve palsy and was diagnosed to have IIH. She was started on acetazolamide. MRI brain showed multiple T2 hyperintensities, so she was referred to Neurology. On exam she had bilateral abduction weakness and her papilledema had resolved. She got spinal tap, opening pressure was 19cm of H2O and spinal fluid analysis was normal. Repeat MRI brain and orbits was negative for optic neuritis and multiple T2 hyperintensities persisted. She had extensive autoimmune and infectious workup which were negative. She had low thiamine level’s [3nmol/L (8-30nmol/L)] and was started on intravenous thiamine. She was discharge home on acetazolamide and thiamine. Her diplopia had resolved when she was seen in the clinic 2wks later. Conclusions: Idiopathic intracranial hypertension and Thiamine deficiency are well known to cause oculomotor dysfunction. Most patients with IIH will have significant nausea and vomiting and are prone to develop vitamin deficiencies. Measuring thiamine levels can help us diagnose and treat Wernicke’s encephalopathy and prevent significant morbidity. <b>Disclosure:</b> Dr. Srikanth-Mysore has nothing to disclose. Dr. Marky has nothing to disclose.