Diagnosing and Managing a Case with a Fourth Nerve Palsy and Papilledema_Crismson Publishers

Diagnosing and Managing a Case with a Fourth Nerve Palsy andPapilledema by Alfonso Casado in Medical & Surgical Ophthalmology Research

A 14-year-old boy presented to the Hospital with new-onset vertical binocular diplopia. Medical history was notable for a recent cranial traumatism. On examination, visual acuity was 20/20 in each eye. Pupils were equal and reactive. Visual fields (VF) were full to confrontation. A slight right head-tilt was observed (Figure 1A), as well as a left hypertropia of 3 Diopters (DP) in primary gaze. Ductions and versions revealed mild over-elevation in adduction and under-depression in adduction on the left eye. Left side Bielschowski maneuver was positive (Figure 1B). Red filter in right eye-test showed an oblique diplopia, but the patient had no torsion on Maddox testing. However, dilated fundus examination revealed bilateral fundus torsion and papilledema (Figure 2). Optical coherence tomography (OCT) revealed an abnormal thickness of the retinal nerve fiber layer (RNFL) and a normal values of retinal ganglion cells (GC).

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