title: Spontaneous intracranial hypotension with unique strabismus due to third and fourth cranial neuropathies.
abstract: OBJECTIVE
  To report an atypical case of Spontaneous Intracranial Hypotension (SIH) with bilateral trochlear nerve palsies and an oculomotor nerve palsy.
  
  
  METHODS
  Case report and literature review. RESULTS (CASE REPORT): A 42 year old man was treated for SIH. His neurological symptoms resolved following neurosurgical treatment with the exception of diplopia due to bilateral trochlear nerve palsies and a pupil-sparing oculomotor nerve palsy. The cranial nerve palsies are believed to be secondary to brainstem ischemia and compression occurring during the acute phase of events. They did not spontaneously improve, but were treated successfully with eye muscle surgery.
  
  
  CONCLUSIONS
  SIH is a rare disease that has been associated with a variety of symptoms and signs including cranial neuropathies. A diagnosis of SIH should be considered in a patient presenting with headache, diplopia secondary to cranial neuropathy and typical radiologic features. This is the first reported case in which bilateral trochlear nerve paresis has been reported in association with this condition.
authors.affiliation: The Cullen Eye Institute, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030-2499, USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Brady-McCreery
authors.forename: Silvia
authors.initials: S
authors.lastname: Speidel
authors.forename: Mohamed A W
authors.initials: MA
authors.lastname: Hussein
authors.forename: David K
authors.initials: DK
authors.lastname: Coats
mesh_terms: D000328:Adult; D004172:Diplopia / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D019585:Intracranial Hypotension / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009801:Oculomotor Muscles / Q000601:surgery; D015840:Oculomotor Nerve Diseases / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D013285:Strabismus / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D020432:Trochlear Nerve Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery