Pseudotumor cerebri with transient oculomotor palsy

Area of Science:

• Neurology
• Ophthalmology

Background:

• Pseudotumor cerebri (PTC) is a neurological disorder characterized by elevated intracranial pressure (ICP) without hydrocephalus or mass lesions.
• Common symptoms include headache, visual disturbances like diplopia, and signs of increased ICP such as papilledema.
• While often idiopathic, secondary causes like infections and certain medications are identified in pediatric cases.

Observation:

• This report details a rare case of PTC presenting with a left oculomotor nerve palsy.
• Notably, the pupillary fibers were spared, which is an unusual finding in oculomotor nerve involvement.
• The patient's condition was managed with oral acetazolamide.

Findings:

• The case demonstrates that oculomotor nerve palsy, even with pupillary sparing, can be associated with pseudotumor cerebri.
• Treatment with acetazolamide led to the resolution of both the pseudotumor cerebri symptoms and the oculomotor palsy.
• This suggests acetazolamide is an effective treatment option for PTC-induced oculomotor nerve palsies.

Implications:

• This case expands the known spectrum of neurological complications associated with pseudotumor cerebri.
• It highlights the importance of considering PTC in the differential diagnosis of isolated oculomotor nerve palsies, especially those with atypical features like pupillary sparing.
• The successful resolution with acetazolamide supports its use in managing such rare presentations, potentially preventing long-term visual morbidity.