Ophthalmoparesis in idiopathic intracranial hypertension

PURPOSE: To report unusual ocular motility disturbances in the setting of idiopathic intracranial hypertension (IIH). DESIGN: Interventional case series. METHODS: Two cases with IIH and unusual ophthalmopareses are reported. RESULTS: Two patients with confirmed IIH presented with headache, diplopia, and papilledema. The first patient had bilateral sixth nerve palsies and a partial right third nerve palsy, which resolved rapidly after a cerebro spinal fluid (CSF) shunting procedure; the second patient had alternating skew deviation and upbeat nystagmus. Both cases had normal brain magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) and normal CSF contents, ruling out a secondary cause of intracranial hypertension. CONCLUSIONS: These exceptional vertical and horizontal ophthalmopareses in the setting of IIH may be related directly to very elevated CSF pressures and may be secondary to altered CSF flow in the posterior fossa.