Headache with Isolated Sixth Cranial Nerve Palsy in an Overweight Woman: A Case of Idiopathic Intracranial Hypertension

Goe Xian Jeff; Sharifah Najwa Syed Mohamad; Siti Noorfaezah Abdul Kadir; Syed Hussein Barakbah

doi:10.33102/mjosht.v10i1.381

Authors

Goe Xian Jeff Emergency Department, Hospital Tuanku Jaafar, Ministry of Health Malaysia, Jalan Rasah, Seremban, 70300, Malaysia.
Sharifah Najwa Syed Mohamad Family Medicine Unit, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Persiaran Ilmu, Nilai, 71800, Malaysia.
Siti Noorfaezah Abdul Kadir Emergency Department, Hospital Tuanku Jaafar, Ministry of Health Malaysia, Jalan Rasah, Seremban, 70300, Malaysia.
Syed Hussein Barakbah Emergency Department, Hospital Tuanku Jaafar, Ministry of Health Malaysia, Jalan Rasah, Seremban, 70300, Malaysia.

DOI:

https://doi.org/10.33102/mjosht.v10i1.381

Keywords:

abducens nerve palsy, intracranial hypertension, diplopia, headache

Abstract

Idiopathic intracranial hypertension (IIH), also known as pseudotumour cerebri, has an estimated incidence of 1 to 2 in 100,000 people per year. IIH commonly affects obese young women, where its pathogenesis, however, is not clearly understood. Patients present to the emergency department with a wide array of presentations. In light of this, we present a case of isolated sixth cranial nerve palsy in a non-obese young woman due to IIH in which brain imaging studies showed no abnormality; however, lumbar puncture reveals an opening pressure of more than 50 cmH2O. This case would help to alert physicians to consider IIH as one of the differential diagnoses when encountering such cases, as an uncommon presentation in the non-obese patient, and prompt referral is important to avoid unnecessary delay in the treatment of IIH.

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