Purpose: To report an atypical case of Spontaneous Intracranial Hypotension (SIH) with bilateral trochlear nerve palsies and an oculomotor nerve palsy.
Design & method: Case report and literature review. RESULTS (CASE REPORT): A 42 year old man was treated for SIH. His neurological symptoms resolved following neurosurgical treatment with the exception of diplopia due to bilateral trochlear nerve palsies and a pupil-sparing oculomotor nerve palsy. The cranial nerve palsies are believed to be secondary to brainstem ischemia and compression occurring during the acute phase of events. They did not spontaneously improve, but were treated successfully with eye muscle surgery.
Conclusion: SIH is a rare disease that has been associated with a variety of symptoms and signs including cranial neuropathies. A diagnosis of SIH should be considered in a patient presenting with headache, diplopia secondary to cranial neuropathy and typical radiologic features. This is the first reported case in which bilateral trochlear nerve paresis has been reported in association with this condition.