Bilateral 6th Nerve Palsies Due to Idiopathic Intracranial Hypertension
Creator
Daniel R. Gold, DO; Stephen Reich, MD
Affiliation
(DRG) Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine, Baltimore, Maryland; (SR) Professor of Neurology, The Frederick Henry Prince Distinguished Professor in Neurology, Department of Neurology, University of Maryland School of Medicine, College Park, Maryland
Subject
Sixth Nerve Palsy; Abnormal Range
Description
This is a 25-year-old woman who presented with diplopia and blurry vision. On exam, she was found to have papilledema and bilateral 6th nerve palsies. Her opening pressure was >40 cm of water with a normal CSF analysis, and neuroimaging was unremarkable aside from subtle findings that have been associated with elevated intracranial pressure (e.g., partially empty sella, distended optic nerve sheaths, flattening of the posterior sclera). Idiopathic intracranial hypertension was diagnosed, and Diamox therapy was initiated. There was gradual resolution of papilledema and 6th nerve palsies over weeks. Because the 6th nerve is fixed where it pierces the dura, either elevated or low intracranial pressure can be lead to unilateral or bilateral 6th nerve palsies.
