Two cases of fourth nerve palsy in pregnancy

Amrit Sehmi,Jamil Hakim,G.G.W Adams

doi:10.22599/bioj.103

Abstract

Aim: To present two cases of recent-onset fourth nerve palsies during pregnancy.Methods: Two pregnant patients presented to A&E with recent-onset diplopia due to isolated right superior oblique palsy. Patient 1, aged 42, complained of a 5-day history of intermittent vertical diplopia at 38 weeks gestation. Patient 2, aged 34, presented with constant horizontal and vertical diplopia at 34 weeks gestation.Results: Two months after giving birth, patient 1 attended the eye clinic reporting her symptoms had completely resolved within 5 days from onset. Patient 2 reported her symptoms resolved within 3 months. Both patients fully recovered, therefore no further management or investigation was required. They both gave birth at term without complication. Patient 1 presented with a slight hyperphoria in primary position, demonstrating binocular single vision (BSV). Ocular motility and Hess chart showed a very slight right superior oblique under-action. Her blood pressure, fundus and media were normal and no underlying pathology was found. No further investigations were undertaken. Patient 2 presented with a slight exotropia and right hypertropia in primary position, with diplopia and no BSV demonstrable. Further orthoptic testing showed right superior oblique under-action. No pathology was found.Conclusions: Cranial nerve palsies developing in pregnancy are rare but have been reported. No pathology was found in our cases; however, the literature does suggest that serious cases could be apparent and should therefore be considered.

Highlights

We present two cases of acute-onset fourth nerve palsies during pregnancy
Sixth nerve palsy would be the most likely cranial nerve palsy if the blood pressure was elevated due to preeclampsia
Preeclampsia is a disorder of pregnancy characterised by high blood pressure and large amounts of protein in the urine

Summary

Introduction

We present two cases of acute-onset fourth nerve palsies during pregnancy. Cranial nerve palsy in pregnancy is a rare occurrence, with only 3 cases of fourth nerve palsyCorrespondence and offprint requests to: Amrit Kaur Sehmi, Orthoptic Department, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD. e-mail: Amrit.Sehmi@ moorfields.nhs.uk reported. We present two cases of acute-onset fourth nerve palsies during pregnancy. Cranial nerve palsy in pregnancy is a rare occurrence, with only 3 cases of fourth nerve palsy. Correspondence and offprint requests to: Amrit Kaur Sehmi, Orthoptic Department, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD. Wide-ranging aetiologies are reported in the literature. A 42-year-old woman, in her first pregnancy, presented at 38 weeks of gestation to eye casualty with intermittent diplopia. The vertical diplopia had been present over 4 days with sudden onset, worse on laevoversion. Since its onset the patient reported no change in severity or frequency of diplopia

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