An Unusual Presentation of Diplopia in the Setting of Idiopathic Intracranial Hypertension

Idiopathic Intracranial Hypertension (IIH) is a Neuro-ophthalmic condition of raised intracranial pressure resulting in headache, papilledema, and potentially diplopia secondary to a sixth nerve palsy. The diagnostic criteria, or Dandy Criteria, specifically restricts focal neurologic deficits other than a sixth nerve palsy. A seventh nerve palsy has been well established as another possible isolated cranial neuropathy secondary to raised intracranial pressure (1, 2, 3, 4). The authors report a patient with fulminant IIH who presented with bilateral fourth and sixth nerve palsies but otherwise met the Dandy criteria and responded well to acetazolamide and ventriculoperitoneal (VP) shunting. This has rarely been presented in the literature prior (5, 6, 7, 8) and may be under recognized as a potential cranial nerve palsy in IIH.