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Julia E Reid, Rachel E Reem, Shawn Aylward, David Rogers; Sixth nerve palsy in pediatric idiopathic or secondary intracranial hypertension. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):2229.
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© ARVO (1962-2015); The Authors (2016-present)
To report the incidence and describe the characteristics of sixth cranial nerve (CN VI) palsy in pediatric patients with intracranial hypertension (IH).
A retrospective chart review of central Ohio children diagnosed with IH over the 3-year period from 2010 to 2013 was conducted. IH without identifiable cause was defined as idiopathic intracranial hypertension (IIH), while IH with identifiable pathologic etiology was deemed secondary intracranial hypertension (SIH). A subset of patients with CN VI palsy was identified. Data collected included patient age, gender, past medical history, etiology of SIH, ophthalmic exam, lumbar puncture results, neuroimaging results, and response to treatment.
Seventy-nine children with intracranial hypertension were included in the study. Ten (13%) children (4 males, 6 females; median age 15, range 3-18) were found to have a unilateral (n=3) or bilateral (n=7) CN VI palsy. Six children had IIH; the remaining four had SIH from cerebral venous sinus thrombosis (n=3) and rocky mountain spotted fever (n=1). The mean opening pressure for these patients was 40 cm H20 (range: 21-65 cm H20). Papilledema was present in 9/10 (90%) patients. One patient required a lumboperitoneal shunt and two required optic nerve sheath fenestrations in addition to medical management. All cases of CN VI palsy resolved with treatment.
In our primary service area, the incidence of CN VI palsy is 13% amongst pediatric IIH and SIH patients. The majority of cases of CN VI palsy occur concurrently with papilledema and commonly resolve with treatment of intracranial hypertension.
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