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Idiopathic intracranial hypertension presenting with isolated unilateral facial nerve palsy: a case report

BACKGROUND: Idiopathic intracranial hypertension, also known as pseudotumor cerebri, is a disorder characterized by increased intracranial pressure of unclear pathogenesis in the absence of other structural and obstructive lesions that is predominantly, although not exclusively, seen in obese women...

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Autores principales: Samara, Ahmad, Ghazaleh, Dana, Berry, Brent, Ghannam, Malik
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474063/
https://www.ncbi.nlm.nih.gov/pubmed/30999940
http://dx.doi.org/10.1186/s13256-019-2060-5
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author Samara, Ahmad
Ghazaleh, Dana
Berry, Brent
Ghannam, Malik
author_facet Samara, Ahmad
Ghazaleh, Dana
Berry, Brent
Ghannam, Malik
author_sort Samara, Ahmad
collection PubMed
description BACKGROUND: Idiopathic intracranial hypertension, also known as pseudotumor cerebri, is a disorder characterized by increased intracranial pressure of unclear pathogenesis in the absence of other structural and obstructive lesions that is predominantly, although not exclusively, seen in obese women of childbearing age. Patients with idiopathic intracranial hypertension commonly present with a headache, transient visual obscurations, and intracranial noises with some cranial nerves occasionally involved, most commonly CN VI. We report idiopathic intracranial hypertension presenting with isolated complete unilateral facial nerve palsy, as the sole cranial nerve involved, which is a presentation rarely reported in the literature. CASE PRESENTATION: A 40-year-old Hispanic woman with a history of obesity and hypertension presented to our emergency department complaining of bifrontal headache for 3 days associated with nausea, vomiting, transient visual disturbances, and a picture of right-sided cranial nerve VII palsy. Her neurologic examination including other cranial nerves was otherwise normal, but a fundus examination revealed bilateral grade II papilledema. Imaging studies ruled out structural and obstructive lesions as possible causes of her symptoms and lumber puncture results were unremarkable except for an increased opening pressure. She was then started on prednisone and acetazolamide. Two days later, she reported a dramatic improvement in both headache and facial nerve palsy. CONCLUSIONS: Idiopathic intracranial hypertension should be suspected in obese young women presenting with headache and transient visual complaints and some cranial nerve abnormalities. Idiopathic intracranial hypertension is a diagnosis of exclusion and imaging studies should always be performed to rule out other structural and obstructive lesions. In this case report, we aimed to draw attention to the possibility of idiopathic intracranial hypertension presenting with unilateral cranial nerve VII palsy as the only cranial nerve involved, which needs a high index of suspicion by clinicians. The mechanisms of cranial nerve VII palsy in idiopathic intracranial hypertension are not well understood and prompt further investigation.
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spelling pubmed-64740632019-04-24 Idiopathic intracranial hypertension presenting with isolated unilateral facial nerve palsy: a case report Samara, Ahmad Ghazaleh, Dana Berry, Brent Ghannam, Malik J Med Case Rep Case Report BACKGROUND: Idiopathic intracranial hypertension, also known as pseudotumor cerebri, is a disorder characterized by increased intracranial pressure of unclear pathogenesis in the absence of other structural and obstructive lesions that is predominantly, although not exclusively, seen in obese women of childbearing age. Patients with idiopathic intracranial hypertension commonly present with a headache, transient visual obscurations, and intracranial noises with some cranial nerves occasionally involved, most commonly CN VI. We report idiopathic intracranial hypertension presenting with isolated complete unilateral facial nerve palsy, as the sole cranial nerve involved, which is a presentation rarely reported in the literature. CASE PRESENTATION: A 40-year-old Hispanic woman with a history of obesity and hypertension presented to our emergency department complaining of bifrontal headache for 3 days associated with nausea, vomiting, transient visual disturbances, and a picture of right-sided cranial nerve VII palsy. Her neurologic examination including other cranial nerves was otherwise normal, but a fundus examination revealed bilateral grade II papilledema. Imaging studies ruled out structural and obstructive lesions as possible causes of her symptoms and lumber puncture results were unremarkable except for an increased opening pressure. She was then started on prednisone and acetazolamide. Two days later, she reported a dramatic improvement in both headache and facial nerve palsy. CONCLUSIONS: Idiopathic intracranial hypertension should be suspected in obese young women presenting with headache and transient visual complaints and some cranial nerve abnormalities. Idiopathic intracranial hypertension is a diagnosis of exclusion and imaging studies should always be performed to rule out other structural and obstructive lesions. In this case report, we aimed to draw attention to the possibility of idiopathic intracranial hypertension presenting with unilateral cranial nerve VII palsy as the only cranial nerve involved, which needs a high index of suspicion by clinicians. The mechanisms of cranial nerve VII palsy in idiopathic intracranial hypertension are not well understood and prompt further investigation. BioMed Central 2019-04-19 /pmc/articles/PMC6474063/ /pubmed/30999940 http://dx.doi.org/10.1186/s13256-019-2060-5 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Samara, Ahmad
Ghazaleh, Dana
Berry, Brent
Ghannam, Malik
Idiopathic intracranial hypertension presenting with isolated unilateral facial nerve palsy: a case report
title Idiopathic intracranial hypertension presenting with isolated unilateral facial nerve palsy: a case report
title_full Idiopathic intracranial hypertension presenting with isolated unilateral facial nerve palsy: a case report
title_fullStr Idiopathic intracranial hypertension presenting with isolated unilateral facial nerve palsy: a case report
title_full_unstemmed Idiopathic intracranial hypertension presenting with isolated unilateral facial nerve palsy: a case report
title_short Idiopathic intracranial hypertension presenting with isolated unilateral facial nerve palsy: a case report
title_sort idiopathic intracranial hypertension presenting with isolated unilateral facial nerve palsy: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474063/
https://www.ncbi.nlm.nih.gov/pubmed/30999940
http://dx.doi.org/10.1186/s13256-019-2060-5
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