Seventh nerve palsy as a false localizing sign in benign intracranial                hypertension

Kearsey, Christopher; Fernando, P.; Benamer, Hani Ts; Buch, Harit

doi:10.1258/jrsm.2010.100049

Cited by 13 publications

(11 citation statements)

References 8 publications

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“…The pathophysiology of facial palsy in IIH is not known but likely represents a pressure-related phenomenon. The seventh nerve run only a short course in the subarachnoid space before entering the petrous temporal bone and is relatively protected from the effects of elevated pressure (28). Two reports (28,29) related it to elevated ICP in the posterior fossa and enlargement of fallopian canals and it usually resolves after lowering ICP.…”

Section: Discussionmentioning

confidence: 99%

Demographics, Clinical Characteristics, and Management of Idiopathic Intracranial Hypertension in Kuwait: A Single-Center Experience

et al. 2020

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Background: Idiopathic intracranial hypertension (IIH) affects predominantly obese females during their reproductive age period. The demographics of this condition has not been studied in Kuwait before. Objectives: To determine the demographics, clinical features, risk factors, and treatment modalities of IIH in the main neurology tertiary referral hospital in Kuwait and to compare our data with literature. Methods: A retrospective study was conducted to identify cases of IIH seen between January 1, 2018, and December 31, 2018. Patients were diagnosed in and referred from the neurology and neuro-ophthalmology clinics. Results: Our cohort consisted of 139 patients. We estimated a crude annual incidence rate of IIH of 3.28 per 100,000 population. Female-to-male ratio was 9.6:1. Mean age was 32.1 ± 10.8 years. Mean age of males was 31.46 ± 12.63 and that of females was 32.11 ± 10.67. The median of the duration from the first symptoms till diagnosis was 6 weeks (2-10 weeks). Headache was the most common symptom in 134 (96.4%) patients, followed by visual disturbances in 85 (61.2%) patients, transient visual obscurations (TVOs) in 84 (60.4%) patients, pulsatile tinnitus in 72 (51.8%) patients, diplopia in 22 (15.8%) patients, other symptoms (e.g., nausea, vomiting, radicular neck, and back pain) in 19 (13.7%) patients, and 1 (0.7%) patient had facial weakness. High body mass index (BMI) was seen in 89.9% of patients, either overweight or obese, and it was the most common risk factors in both males (46.2%) and females (61.1%). Anemia was found in 38.1%; 21.6% of patients used OCPs and 7.9% used vitamin A. Bilateral transverse sinus stenosis (BTSS) was detected in 47 (33.8%) patients. Only 2 (1.4%) patients developed "fulminant IIH" characterized by rapidly progressive disease. All the patients received medical treatment and only 12 (8.6%) needed surgical management. Al-Hashel et al. Idiopathic Intracranial Hypertension in Kuwait Conclusion: Incidence of IIH in Kuwait is similar to other regional studies but higher than Western studies. Demographics and clinical features of IIH in our study are comparable to international and regional figures. Most of our patients had a benign course. IIH is more prevalent in females and strongly associated with obesity.

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Section: Discussionmentioning

confidence: 99%

Demographics, Clinical Characteristics, and Management of Idiopathic Intracranial Hypertension in Kuwait: A Single-Center Experience

et al. 2020

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“…In contrast, the anatomy of the seventh nerve makes it less prone to such an effect. From the motor nucleus in the pons, facial nerve fibers wrap around the sixth nerve nucleus forming the facial colliculus and then run a relatively short course before reaching the petrous part of the temporal bone where it resides, somehow protected from pressure effects [11]. Given these facts, it is extremely unusual to have an isolated facial nerve palsy from high ICP, with the abducens nerve usually spared.…”

Section: Discussionmentioning

confidence: 99%

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

Samara¹,

Ghazaleh²,

Berry³

et al. 2019

J Med Case Reports

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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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“…In all reported cases of IIH through 1997 and thereafter, CN involvement was temporally associated with increased ICP and subsequently significantly improved or resolved with management of the underlying pressure. [9][10][11] Further evidence for this hypothesis is found in a case of a child with a ventriculoperitoneal shunt who presented with facial diplegia secondary to shunt malfunction and saw complete resolution of their facial diplegia with correction of ICP. 12 Experimental studies have shown a close relationship between pressure in the CSF and pressure on the CNs 13 adding further evidence to this effect.…”

Section: Letter To the Editor To The Editor Facial Nerve Palsy From Cmentioning

confidence: 98%

Facial Nerve Palsy from Cerebral Venous Sinus Thrombosis: An Effect of Increased ICP

Hussain

Siddiqui

2017

Can. J. Neurol. Sci.

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Seventh nerve palsy as a false localizing sign in benign intracranial hypertension

Cited by 13 publications

References 8 publications

Demographics, Clinical Characteristics, and Management of Idiopathic Intracranial Hypertension in Kuwait: A Single-Center Experience

Demographics, Clinical Characteristics, and Management of Idiopathic Intracranial Hypertension in Kuwait: A Single-Center Experience

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

Facial Nerve Palsy from Cerebral Venous Sinus Thrombosis: An Effect of Increased ICP

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