Hayat GÜVEN, Aslı Ece ÇİLLİLER, Selim Selçuk ÇOMOĞLU, Şennur KATI DELİBAŞ

Pseudotumor Cerebri Presenting With Multiple Cranial Nerve Palsy: A Case Report

Psödotümör serebri (PS), kafa içi yer kaplayıcı lezyon veya ventrikülomegali olmaksızın intrakraniyal basınç artışı ile karakterize bir sendromdur. PS’li hastalarda 6. kraniyal sinir dışında diğer kraniyal sinir tutulumları nadiren bildirilmiştir. Bu yazıda, başağrısı ve diplopi ile başvuran ve muayenesinde; bilateral papil ödemin yanı sıra bilateral 6. kraniyal sinir paralizisi, unilateral 7. ve 3. kraniyal sinir tutulumları saptanan bir olgu sunulmuştur. Beyin omurilik sıvısı (BOS) basıncının artmış bulunması ve normal radyolojik bulgular sonucunda hastaya PS tanısı konulmuştur. PS’li hastalarda beklenen abdusens sinir paralizisine ek olarak, 3. ve 7. kraniyal sinir tutulumlarının da eşlik edebildiği atipik prezentasyonların olabileceği akılda tutulmalıdır.

Multipl Kraniyal Sinir Paralizisinin Eşlik Ettiği Psödotümör Serebri: Olgu Sunumu

Pseudotumor cerebri (PC) is a syndrome defined by increased intracranial pressure without an intracranial spaceoccupying lesion or ventriculomegaly. The involvement of the cranial nerves, rather than the sixth cranial nerve, has been rarely reported in patients with PC. In this case report, a patient with headache and diplopia was presented. The neurological examination of the patient revealed bilateral papilledema with bilateral sixth nerve palsy and unilateral seventh and third cranial nerve involvement . Owing to the increased cerebrospinal fluid (CSF) pressure and normal radiological findings, the patient was diagnosed as PC. It should be considered that there may be PC patients with atypical presentations such as third and seventh cranial nerve involvement, in addition to the expected abducens nerve paralysis.

PDF

___

1. Kansu T. Papilledema and idiopathic intracranial hypertension (Pseudotumor Cerebri). Turkiye Klinikleri J Surg Med Sci 2006;2(14):8-11.
2. Agarwal MP, Mansharamani GG, Dewan R. Cranial nerve palsies in benign intracranial hypertension. J Assoc Physician India 1989;37 (8): 533- 534.
3. Bakshi SK, Oak JL, Chawla KP, Kulkarni SD, Apte N. Facial nerve involvement in pseudotumor cerebri. J Postgrad Med 1992;38 (3):144- 145.
4. Brackmann DE, Doherty JK. Facial palsy and fallopian canal expansion associated with idiopathic intracranial hypertension. Otol Neurootol 2007; 28 (5): 715- 718.
5. Capobianco DJ, Brazis PW, Cheshire WP. Idiopathic intracranial hypertension and seventh nerve palsy. Headache 1997;37(5): 286- 288.
6. Kiwak KJ, Levine SE. Benign intracranial hypertension and fascial diplegia. Arch Neurol 1984;41 (7): 787-788.
7. Diaz Espejo CE, Chaves FV, Ramis BS. Chronic intracranial hypertension secondary to neurobrucellosis. J Neurol 1987;234 (1):59- 61.
8. Macaya A, Roig M, Fernandez JM, Boronat M. Pseudotumor cerebri, spinal and radicular pain and hyporeflexia: a clinical variant of the Guillain Barre syndrome? Ped Neurol 1988;4 (2): 120- 121.
9. Mc Cammon A, Kaufmann HH, Sears SE. Transient oculomotor paralysis in pseudotumor cerebri. Neurology 1981;31(2): 182- 184.
10. Selky AK, Dobyns WB, Yee RD. Idiopathic intracranial hypertension and facial diplegia. Neurology 1994;44 (2): 357.
11. Zachariah SB, Jimenez L, Zachariah B, Prockop LD. Pseudotumor cerebri with focal neurologic defisit. J Neurol Neurosurg Psychiatry 1990;53 (4): 360- 361.