Complete bilateral ophthalmoplegia in malignant intracranial hypertension in a child

Area of Science:

• Ophthalmology
• Neurology
• Pediatrics

Background:

• Idiopathic intracranial hypertension (IIH) typically presents with headache, visual disturbances, and papilledema.
• Fulminant or "malignant" presentations of IIH are rare, especially in pediatric cases.

Purpose of the Study:

• To document a unique case of fulminant idiopathic intracranial hypertension (IIH) in a pediatric patient.
• To highlight a severe, atypical presentation of IIH with profound visual loss and ophthalmoplegia.

Main Methods:

• Case report of a 16-year-old female with acute bilateral visual loss and ophthalmoplegia.
• Diagnostic workup included MRI and lumbar puncture to confirm IIH.
• Exclusion of infectious, inflammatory, autoimmune, and neoplastic causes.

Main Results:

• Diagnosis of IIH confirmed by elevated intracranial pressure and MRI findings.
• Patient presented with severe vision loss and complete limitation of eye movements, notably without headache.
• Optic disc edema and extraocular motility showed partial improvement, but visual acuity remained significantly impaired.

Conclusions:

• A severe, acute, and fulminant ("malignant") presentation of IIH can cause unique symptoms like complete ophthalmoplegia and severe vision loss.
• The absence of headache in this IIH case is noteworthy.
• This represents the first reported case of such a "malignant" IIH presentation in the English ophthalmic literature.