Abstract
Purpose
Isolated oculomotor nerve palsy in preeclampsia patients have not been reported in Korea. Herein, we report 1 case of a patient in her 32nd week of gestation diagnosed with preeclampsia experiencing oculomotor nerve palsy in the left eye which improved after delivery.
Case summary
A 28-year-old pregnant woman in her 32nd week of gestation with no underlying diseases visited our clinic with the chief complaint of diplopia and left eye ptosis. The patient suffered headache symptoms 1 week prior and did not undergo any exams. The visual acuity, anterior segment, and, fundus showed no abnormal signs and the pupil light reflex was normal, but the patient showed left eye ptosis with +2 mm/-2 mm on the marginal reflex distance (MRD) exam, 25 prism exotropia and 6 prism hypotropia, supraduction and adduction limitation -2 and, infraduction limitation -1. To exclude other systemic disorders and brain lesions, laboratory tests and brain magnetic resonance imaging (MRI) was performed, and preeclampsia was diag-nosed based on high blood pressure (150/110 mm Hg) and mild proteinuria. Imaging and labatory tests showed other disorders thus the patient was treated conservatively. Two weeks after the ocular symptoms appeared, the left ptosis and ocular move-ment restriction worsened, but systemic signs and tests shown no aggravation, thus we maintained conservative therapy and af-ter delivery at 37-weeks, the symptoms slowly improved and recovered completely after 2 months.
References
1. Bonebrake RG, Fleming AD, Carignan EM, Hoover DK. Severe preeclampsia presenting as third nerve palsy. Am J Perinatol. 2004; 21:153–5.
2. Chutatape A, Teoh WH. Third nerve palsy associated with pre-eclampsia and HELLP syndrome. J Anesth. 2013; 27:757–60.
3. Watanabe H, Hamada H, Fujiki Y. . Third nerve palsy and se-rous retinal detachment with preeclampsia. Hypertens Pregnancy. 2006; 25:33–5.
4. Lee KM, Park YH, Lee SY, Lee YC. A case of abducens nerve pal-sy and disc swelling complicating pregnancy-induced hypertension. J Korean Ophthalmol Soc. 2007; 48:1736–41.
5. Fung TY, Chung TK. Abducens nerve palsy complicating preg-nancy: a case report. Eur J Obstet Gynecol Reprod Biol. 1999; 83:223–4.
6. Barry-Kinsella C, Milner M, McCarthy N, Walshe J. Sixth nerve palsy: an unusual manifestation of preeclampsia. Obstet Gynecol. 1994; 83:849–51.