New member
Dec 17, 2021
A 17-year-old female patient was admitted to the neurology clinic with headache. There is no abnormality in his history. On examination, papilledema was observed in both eyes.


This photo is a sample papilledema photo. (Taken from Wikipedia.)

The causes of papilledema are listed below:
• intracranial masses
• extra-axial collection
• meningeal disease
• granulomatous conditions / infections
• idiopathic intracranial hypertension also known as pseudotumor cerebri
• severe hypertensive retinopathy (due to arterial hypertension)
• progressive stenosis of the optic canals and compressive optic neuropathy

Many of these causes are associated with intracranial pathologies. Therefore, a brain MRI was obtained:


There is edema around the bilateral optic nerve on axial images, and empty sella on sagittal T2 images. And obstruction is seen in venous sinuses. No intracranial mass was detected. These findings suggested pseudotumor cerebri.

Causes of pseudotumor cerebri include:
• endocrine
o adrenal insufficiency
o Cushing's disease
o hypoparathyroidism
o excessive thyroxine replacement in children
• drugs
o doxycycline 2
• chronic renal failure
• systemic lupus erythematosus (SLE)
• hypervitaminosis A (in the population pediatric)
Subsequently, it was learned in the patient's history that she used isotretinoin for acne vulgaris. Isotretinoin caused hypervitaminosis A and intracranial hypertension.

Pseudotumor cerebri may cause long-term vision loss due to compression on the optic nerve. The enlarged blind spot is the first finding in the visual field test.

Difficult question: Which cranial nerve is the first to be damaged in pseudotumor cerebri?
N. Abducens(6 CN)