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[Third cranial nerve palsy due to intracranial hypotension syndrome]

A Alonso Cánovas1, J Martínez San Millán, M E Novillo López

  • 1Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid.

Neurologia (Barcelona, Spain)
|August 30, 2008
PubMed

Insights

Intracranial hypotension syndrome (IHS) can cause rare third cranial nerve (CN) palsy, presenting as vision problems. This case highlights IHS

Area of Science:

  • Neurology
  • Neuro-ophthalmology

Background:

  • Intracranial hypotension syndrome (IHS) is characterized by orthostatic headache due to cerebrospinal fluid (CSF) hypovolemia.
  • Lower cranial nerve (CN) palsies, particularly the 6th CN, are common in IHS, but third CN neuropathy is exceptionally rare.

Observation:

  • A 43-year-old man presented with gradual onset orthostatic headache and vertical diplopia.
  • Clinical examination revealed an incomplete, pupil-sparing left third CN palsy.
  • Brain and spine MRI confirmed IHS, with low CSF opening pressure and evidence of a prior spinal trauma-induced CSF leak.

Findings:

  • The patient's symptoms improved with conservative management over three months.
  • Cranial MRI showed normalization ten months post-treatment.

Implications:

  • Third CN palsy is an extremely rare manifestation of IHS.
  • This case expands the known clinical spectrum of intracranial hypotension syndrome.
Abstract

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