A case of multiple cranial nerve palsies as the initial ophthalmic presentation of antiphospholipid syndrome.

Antiphospholipid syndrome (APS) is an autoimmune disease in which patient are positive for lupus anticoagulant and anticardiolipin antibody with clinical symptoms of thrombosis, recurrent abortion, and thrombocytopenia. In the absence of clinical evidence of other autoimmune diseases the disease is referred to as primary APS. APS is associated with a wide range of neurological manifestations. Among these, idiopathic intracranial hypertension (IIH) may occur through mechanisms unrelated to major venous thrombosis. IIH may be associated with ocular motility deficits to our knowledge there is one case of third cranial nerve palsy presenting secondary to IIH in primary APS.1 There are no reported cases of concurrent third, fourth, and sixth cranial nerve palsy presenting secondary to IIH as the initial ophthalmic manifestation of primary APS.