Miller Sarah C, Stafstrom Carl E
Neurology, Johns Hopkins University School of Medicine, Baltimore, USA.
Cureus. 2022 Jul 14;14(7):e26850. doi: 10.7759/cureus.26850. eCollection 2022 Jul.
A four-year-old previously healthy child presented with new-onset, diffuse, severe headache, and left sixth nerve palsy. The child was evaluated at several acute care facilities, at which the symptom of "crossing eyes" was not addressed specifically. At our emergency department, on day 6 of symptoms, a left cranial nerve 6 palsy was diagnosed; on brain MRI scan, there was evidence of increased intracranial pressure (distended optic nerve sheaths, flattened posterior sclerae), which was confirmed by lumbar puncture, which showed an opening pressure of >36 cm HO. Idiopathic intracranial hypertension (IIH) was diagnosed, and all symptoms abated with two months of treatment with acetazolamide. IIH should be considered in a child with headache and abnormal eye movements.
一名4岁既往健康的儿童出现新发的弥漫性严重头痛和左侧展神经麻痹。该儿童在多家急症医疗机构接受了评估，在这些机构中，“斗鸡眼”症状未得到具体诊治。在出现症状的第6天，患儿在我们的急诊科被诊断为左侧第6颅神经麻痹；脑部磁共振成像扫描显示有颅内压升高的迹象（视神经鞘增宽、后巩膜扁平），腰椎穿刺证实了这一点，其初压>36 cm H₂O。诊断为特发性颅内高压（IIH），使用乙酰唑胺治疗两个月后所有症状均缓解。对于有头痛和异常眼动的儿童应考虑IIH。
