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Orbit. 2018 Oct;37(5):371-374. doi: 10.1080/01676830.2017.1423346. Epub 2018 Jan 4.

Intracranial hypotension mimicking chronic progressive external ophthalmoplegia.

Author information

1
a Department of Oculoplastics and Orbital Surgery, Bristol Eye Hospital , Bristol , UK.
2
b Radiology Department , Bristol Royal Infirmary , Bristol , UK.

Abstract

Intracranial hypotension (ICH) is characterized by low cerebrospinal fluid pressure, postural headaches, and diffuse pachymeningeal enhancement on magnetic resonance imaging (MRI). A variety of ophthalmoparetic manifestations have been reported in the context of the ICH. The authors describe an unusual case of a 64-year-old woman who presented with rapid onset of headaches, bilateral upper-lid ptosis, and blurring of vision within 4 days after sustaining a trivial head injury. She was noted to have bilateral symmetrical ophthalmoplegia and ptosis-simulating chronic progressive external ophthalmoplegia. MRI revealed characteristic features of ICH. Subsequent autologous epidural patch therapy led to resolution of the headache and imaging findings; however, her ptosis and motility disorder persisted. Despite existing therapeutic measures for ICH, irreversible cranial nerve damage may ensue due to significant cerebral decent or ischemic injury.

KEYWORDS:

Blepharoptosis; chronic progressive external ophthalmoplegia; epidural patching; intracranial hypotension; upper-lid ptosis

PMID:
29300676
DOI:
10.1080/01676830.2017.1423346
[Indexed for MEDLINE]

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