Third Nerve Palsy and Serous Retinal Detachment with Preeclampsia

Abstract

Visual disturbances occur more frequently during preeclampsia than during pregnancy in general, but visual disturbances due to cranial nerve palsy are rare. We present the case of a 35-year-old preeclamptic woman with left third nerve palsy and left serous retinal detachment. The patient complained of visual disturbance and double vision soon after cesarean section. Left third nerve palsy and left serous retinal detachment were diagnosed by urgent ophthalmologic evaluation. Aneurysm and organic brain lesion were ruled out by diagnostic imaging. By 2 months postpartum, the visual disturbance had improved spontaneously.

Visual Disturbances in (Pre)eclampsia

“…[57][58][59][60][61][62] In an interesting case report, bilateral serous retinal detachment was reported to reveal an occult pregnancy. 63 The onset of preeclampsia-related serous retinal detachment is sudden, the main symptoms are a visual field defect and loss of visual acuity.…”

Isolated reversible hypoglossal nerve palsy as the initial manifestation of pre-eclampsia

“…These reports describe mono-neuropathies involving CN III, VI and VII. [2][3][4][5]10 Due to a greater preponderance during the third trimester, it has been proposed that pregnancy-related CN lesions may be the result of increased extracellular fluid causing perineural oedema and neural compression 5,11 Alternatively a complex vasculopathy (including hypercoagulability) induced by preeclampsia may render the affected nerve ischaemic. 5,11 We favour an ischaemic effect in this patient due to the acuity of onset, a close association with the development of pre-eclampsia and the rarity of hypoglossal ''auto-compression''.…”

Two cases of serous retinal detachment with placental abruption

“…Only 4 case reports have been published on retinal detachment associated with placental abruption. [3][4][5][6] Hoines et al reported a woman of 40 weeks of gestation with vaginal bleeding, dizziness, and blurred vision. 4) Although her systolic blood pressure was normal (110 -120 mmHg), laboratory data showed disseminated intravascular coagulopathy (DIC) with positive proteinuria.…”

“…Watanabe et al reported a woman with chronic hypertension. 5) At 28 weeks of gestation, her blood pressure was elevated at 170/107 mmHg with proteinuria (4 + ). Placental abruption occurred at 31 weeks of gestation, and emergent cesarean section saved the infant.…”