Combined paralysis of the abducens and facial nerves following idiopathic intracranial hypertension

TL;DR

A child with idiopathic intracranial hypertension developed rare combined paralysis of the abducens and facial nerves, highlighting unusual cranial nerve involvement in this condition.

Contribution

Reports a rare case of combined 6th and 7th cranial nerve palsy in a child with idiopathic intracranial hypertension.

Findings

An 8-year-old boy presented with bilateral papilledema and right-sided 6th and 7th cranial nerve palsy.

The patient was diagnosed with pseudotumor cerebri and treated with acetazolamide, prednisolone, and topiramate.

IIH can occasionally involve the 6th and 7th cranial nerves in children, even without typical risk factors.

Abstract

Idiopathic intracranial hypertension (IIH) is a clinical phenomenon that reflects an increase in intracranial pressure in the brain with normal parenchyma and no signs of ventriculomegaly, malignancy, infection, or any space-occupying lesion. Generally, this disease is associated with symptoms such as headache, transient visual obscurations (unilateral or bilateral darkening of the vision typically seconds), intracranial noise, diplopia, blurring of vision, abducens nerve palsies, and unilateral or bilateral facial nerve paresis (which is a very rare complication of this disease that has been reported in some studies).

An 8-year-old boy with a history of bilateral frontal headache for 2 weeks, right ear pain, vomiting, and intermittent fever, who had received antibiotics and analgesics with improvement of ear pain and continuation of headache, presented to this center. In the initial neurological examinations, bilateral papilledema and right-sided 6th and 7th cranial nerve palsy (peripheral) were observed. After performing LP and CT scan and MRV for the patient, a diagnosis of pseudotumor cerebri was made and he was treated with acetazolamide, prednisolone, and topiramate. He was discharged after 10 days.

Although pseudotumor cerebri is less common in children than adults and obesity and female gender are considered as risk factors for this disease, it is not usually associated with involvement of the 6th and 7th cranial nerves. However, sometimes this disease can occur in children without any risk factors and with less common involvement of the 6th and 7th cranial nerves.

•Idiopathic intracranial hypertension is a clinical phenomenon that reflects an increase in intracranial pressure.•IIH is divided into two types based on the underlying cause.•Sometimes IIH occur in children with involvement of the 6th and 7th cranial nerves.

Idiopathic intracranial hypertension is a clinical phenomenon that reflects an increase in intracranial pressure.

IIH is divided into two types based on the underlying cause.

Sometimes IIH occur in children with involvement of the 6th and 7th cranial nerves.