An Unusual Case Of Idiopathic Intracranial Hypertension Presenting With Simultaneous IIIrd, VIth and V11th Nerve Palsies (P6.305)

OBJECTIVE: We describe the case of a 12 year old Female who presented with multiple (IIIrd, VIth and VIIth) cranial nerve palsies and was diagnosed with Idiopathic Intracranial Hypertension (IIH) after a thorough work up BACKGROUND: The patient presented with a 3 week history of neck and back pain, intermittent, monocular double vision, right facial weakness, headaches and blurred vision. She had no fever, travel history, tick bites. She was on minocycline for 2 months for acne DESIGN/METHODS: Neurologic exam revealed 20/100 vision bilaterally, severe papilledema bilaterally with hemorrhages and cotton wool spots, bilateral III and VIth nerve palsies, right LMN VIIth nerve palsy, restriction of temporal visual fields, bilateral arm dysmetria, diminished DTR9s. RESULTS: MRI of the brain and MRV were normal. CSF revealed an opening pressure of >55 cm H2O with normal CSF parameters. A thorough infectious (including Lyme9s), inflammatory (including Sarcoid), rheumatologic, auto immune work up was negative. She was started on acetazolamide with good response and her vision and cranial neuropathies improved. At her 2 month follow up, her vision had improved to 20/25 bilaterally, with full EOM, no facial asymmetry and marked improvement of papilledema. CONCLUSIONS: CN palsies other than VIth nerve are an atypical presentation of IIH and are only described in case reports. Infectious (especially Lyme9s), inflammatory (especially Sarcoid), rheumatologic and other auto immune causes must be ruled out. Treatment should be initiated promptly and offending agents should be discontinued to prevent permanent visual loss. Study Supported by: None Disclosure: Dr. Katyayan has nothing to disclose. Dr. Parachuri has nothing to disclose. Dr. Sallowm has nothing to disclose. Dr. Walsh has nothing to disclose.