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A case of multiple cranial nerve palsies as the initial ophthalmic presentation of antiphospholipid syndrome.

Shin SY, Lee JM - Korean J Ophthalmol (2006)

Bottom Line: There was no clinical evidence of other autoimmune disease.Brain magnetic resonance (MR) imaging, MR angiography, and conventional angiogram with venous phase were normal.To our knowledge this is the first reported case of concurrent third, fourth, and sixth cranial nerve palsies in a patient with primary APS.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Hanyang University Guri Hospital, College of Medicine, Hanyang University, Guri City, Goyang, Korea. eyeshin@hanyang.ac.kr

ABSTRACT

Purpose: To report a case of third, fourth, and six cranial nerve palsies with antiphospholipid syndrome (APS).

Methods: Medical records of a 16-year-old female diagnosed with idiopathic intracranial hypertension (IIH) in primary APS were reviewed.

Results: A 16-year-old female presented with headache and diplopia. Ocular examinations revealed marked bilateral disc edema. She was unable to depress, adduct, and abduct in left eye and had limited abduction in the right eye. Cerebrospinal fluid had a normal composition and a pressure of 400 mmH20. Lupus anticoagulant and IgG anticardiolipin antibody were positive. There was no clinical evidence of other autoimmune disease. Brain magnetic resonance (MR) imaging, MR angiography, and conventional angiogram with venous phase were normal. She was diagnosed with bilateral sixth, and left third and fourth cranial nerve palsies secondary to idiopathic intracranial hypertension in primary APS.

Conclusions: To our knowledge this is the first reported case of concurrent third, fourth, and sixth cranial nerve palsies in a patient with primary APS.

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Nine-gaze eye positions. Range of motion in cardinal position demonstrates impairment of downward, lateral and medial gaze in the left eye, and of lateral gaze in the right eye.
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Figure 1: Nine-gaze eye positions. Range of motion in cardinal position demonstrates impairment of downward, lateral and medial gaze in the left eye, and of lateral gaze in the right eye.

Mentions: Ophthalmic examinations showed a visual acuity of 20/20 in both eyes, a mid dilated pupil of the left eye, and marked bilateral disc edema with peripapillary hemorrhage. She was unable to depress, adduct, and abduct the left eye and had limited abduction of the right eye (Fig. 1). Visual field examination showed peripheral constriction and enlargement of the blind spot in both eyes.


A case of multiple cranial nerve palsies as the initial ophthalmic presentation of antiphospholipid syndrome.

Shin SY, Lee JM - Korean J Ophthalmol (2006)

Nine-gaze eye positions. Range of motion in cardinal position demonstrates impairment of downward, lateral and medial gaze in the left eye, and of lateral gaze in the right eye.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908822&req=5

Figure 1: Nine-gaze eye positions. Range of motion in cardinal position demonstrates impairment of downward, lateral and medial gaze in the left eye, and of lateral gaze in the right eye.
Mentions: Ophthalmic examinations showed a visual acuity of 20/20 in both eyes, a mid dilated pupil of the left eye, and marked bilateral disc edema with peripapillary hemorrhage. She was unable to depress, adduct, and abduct the left eye and had limited abduction of the right eye (Fig. 1). Visual field examination showed peripheral constriction and enlargement of the blind spot in both eyes.

Bottom Line: There was no clinical evidence of other autoimmune disease.Brain magnetic resonance (MR) imaging, MR angiography, and conventional angiogram with venous phase were normal.To our knowledge this is the first reported case of concurrent third, fourth, and sixth cranial nerve palsies in a patient with primary APS.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology, Hanyang University Guri Hospital, College of Medicine, Hanyang University, Guri City, Goyang, Korea. eyeshin@hanyang.ac.kr

ABSTRACT

Purpose: To report a case of third, fourth, and six cranial nerve palsies with antiphospholipid syndrome (APS).

Methods: Medical records of a 16-year-old female diagnosed with idiopathic intracranial hypertension (IIH) in primary APS were reviewed.

Results: A 16-year-old female presented with headache and diplopia. Ocular examinations revealed marked bilateral disc edema. She was unable to depress, adduct, and abduct in left eye and had limited abduction in the right eye. Cerebrospinal fluid had a normal composition and a pressure of 400 mmH20. Lupus anticoagulant and IgG anticardiolipin antibody were positive. There was no clinical evidence of other autoimmune disease. Brain magnetic resonance (MR) imaging, MR angiography, and conventional angiogram with venous phase were normal. She was diagnosed with bilateral sixth, and left third and fourth cranial nerve palsies secondary to idiopathic intracranial hypertension in primary APS.

Conclusions: To our knowledge this is the first reported case of concurrent third, fourth, and sixth cranial nerve palsies in a patient with primary APS.

Show MeSH
Related in: MedlinePlus