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Fourth cranial nerve palsy in pediatric patients with pseudotumor cerebri
C Speer1, J Pearlman, P H Phillips
1Harvey and Bernice Jones Eye Institute, Department of Ophthalmology, University of Arkansas Medical Center, Little Rock, USA.
Insights
Acute fourth cranial nerve palsy can occur in children with pseudotumor cerebri. This condition, marked by increased intracranial pressure, resolved in all cases after treatment.
Area of Science:
- Pediatric Neurology
- Ophthalmology
- Neuro-Ophthalmology
Background:
- Pseudotumor cerebri (idiopathic intracranial hypertension) is a condition characterized by increased intracranial pressure without a clear cause.
- It can affect children and manifest with various neurological symptoms.
Observation:
- This study describes three pediatric cases of acute fourth cranial nerve palsy.
- The palsy presented with vertical diplopia, hypertropia, and increased symptoms with adduction and ipsilateral head tilt.
Findings:
- All three children diagnosed with pseudotumor cerebri exhibited signs of fourth cranial nerve palsy.
- The neurological deficit resolved in all patients following successful reduction of intracranial pressure.
Implications:
- Fourth cranial nerve palsy may serve as a nonspecific indicator of elevated intracranial pressure in pediatric pseudotumor cerebri.
- Early recognition and management of intracranial pressure are crucial for resolving such ocular motor nerve palsies.
Purpose:
To describe three children with acute fourth cranial nerve palsy secondary to pseudotumor cerebri.
Methods:
We reviewed the medical records of children younger than 18 years who were diagnosed with pseudotumor cerebri between 1977 and 1997. Pseudotumor cerebri was defined by normal neuro-imaging, elevated intracranial pressure measured by lumbar puncture, and normal cerebrospinal fluid composition.
Results:
Three children with pseudotumor cerebri presented with vertical diplopia and clinical signs of fourth cranial nerve palsy including a hypertropia of the affected eye, which increased with adduction and ipsilateral head tilt. The fourth cranial nerve palsy resolved after reduction of the intracranial pressure in all three children.
Conclusions:
Fourth cranial nerve palsy may occur in children with pseudotumor cerebri and may be a nonspecific sign of elevated intracranial pressure.