A case of bilateral fourth nerve palsy associated with pseudotumor cerebri syndrome

ABSTRACT Pseudotumor cerebri syndrome is puzzling because it results in elevated intracranial pressure with no identifiable underlying cause. Ocular motor nerve palsies, other than a unilateral or bilateral sixth cranial nerve palsy, are rarely seen in patients with this condition. We report here on a 25-year-old female patient with bilateral fourth cranial nerve palsy caused by pseudotumor cerebri syndrome, whose ocular and systemic signs and symptoms of nerve palsy were completely resolved after medical treatment. We infer that fourth nerve palsy could be associated with pseudotumor cerebri syndrome; therefore, clinicians should consider rare ocular motor nerve palsies, even bilaterally, in patients with pseudotumor cerebri syndrome.

摘要 假脑瘤综合征（pseudotumor cerebri syndrome）的病因始终难以明确，患者可出现颅内压升高，但无法找到可识别的潜在致病诱因。除单侧或双侧展神经麻痹（sixth cranial nerve palsy）外，该病症患者极少出现其他类型的眼运动神经麻痹（ocular motor nerve palsies）。本文报告1例因假脑瘤综合征引发双侧滑车神经麻痹（fourth cranial nerve palsy）的25岁女性患者，其神经麻痹相关的眼部与全身体征及症状在接受药物治疗后完全消退。据此我们推断，滑车神经麻痹可能与假脑瘤综合征存在关联；因此，针对假脑瘤综合征患者，临床医师应警惕罕见的眼运动神经麻痹类型，即便为双侧受累也需纳入鉴别考量。