Abducens nerve paralysis due to idiopathic increased intracranial pressure: a prepubertal case report

Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is characterized by papilledema and elevated intracranial pressure, with normal results of neuroimaging and cerebrospinal fluid studies. It is usually seen in adults and less frequently in adolescents and younger children. We report the case of a 10-year-old boy presenting with severe headache and left horizontal diplopia for 2 weeks. Fundus examination revealed marked bilateral optic disc and macular edema. Brain magnetic resonance imaging (MRI) showed no space-occupying lesions and a partially empty sella. Lumbar puncture revealed an opening pressure of 49 cmH2O with normal results of the cerebrospinal fluid analysis. We diagnosed abducens nerve paralysis due to idiopathic increased intracranial pressure. After 2 weeks of medical treatment, the symptoms completely resolved. We present this rare case of pediatric IIH and a literature review with an overview of the disease characteristics.