Alternating Skew Deviation from Traumatic Intracranial Hypotension.

Area of Science:

• Neurology
• Ophthalmology
• Neuroscience

Background:

• Intracranial hypotension is a condition characterized by low cerebrospinal fluid pressure.
• It can manifest with various neurological symptoms, often following trauma or lumbar puncture.
• Ocular motility disorders are known complications, but specific presentations are infrequently reported.

Observation:

• A 56-year-old woman presented with progressive headache, altered mental status, and diplopia after experiencing head trauma.
• Diagnostic workup revealed intracranial hypotension as the underlying cause.
• The patient was diagnosed with alternating skew deviation, an abnormal eye movement disorder.

Findings:

• This case represents the first documented instance of alternating skew deviation associated with intracranial hypotension.
• The development of alternating skew deviation in this context is hypothesized to be related to pressure differentials between the intracranial and intraspinal compartments.
• This suggests a novel mechanism for ocular motor dysfunction in hypotension.

Implications:

• The findings expand the spectrum of neurological manifestations of intracranial hypotension.
• Alternating skew deviation should be considered in the differential diagnosis of patients with intracranial hypotension and visual disturbances.
• Further research is warranted to elucidate the precise pathophysiology linking pressure gradients to skew deviation.