Düşük Serum Vitamin A Düzeyi ve Benign Rekürren Altıncı Sinir Paralizisi: Olgu Sunumu

Abstract

Çocukluk çağında görülen altıncı sinir paralizisi artmış intrakraniyal basınç, neoplazm, travma, yada öncesinde geçirilmiş viral veya bakteriyel enfeksiyon ile ilişkilidir. Tekrarlayan altıncı sinir paralizisi nadir görülen bir klinik tablodur ve etiyolojisi halen belirsizdir. Sol gözde sekiz ay ara ile tekrarlayan dışa bakış kısıtlılığı ve baş ağrısı şikayeti ile polikliniğimize sevkedilen hastaya rekürren altıncı sinir paralizi tanısı konulmuştur. Vitamin A düzeyleri düşük bulunan hastanın semptomları vitamin A tedavisi ile düzelmiştir. Hastamızda ailenin izin vermemesi nedeniyle lumbar ponksiyon yapılamamıştı. Ancak hastanın intrakraniyal basınç artışı bulguları ile uyumlu, günün sabah kısmında olan baş ağrıları, altıncı sinir paralizisi olması nedeniyle, papil stazı izlenmese dahi idiopatik intrakranial hipertansiyon lehine düşünülmüştür. Düşük vitamin A düzeyleri sonucu oluşan idiopatik intrakranial hipertansiyon olguları da literatürde yayınlanmıştır. Rekürren altıncı sinir paralizi olan hastalarda idiopatik intrakranial hipertansiyon düşünülmesi ve etiyolojik nedenler arasında yer alan vitamin A düzeylerinin bakılması önerilir.

Keywords

• Benign tekrarlayan altıncı sinir paralizisi, İdiopatik intrakranial hipertansiyon, Pseudotümör serebri, Vitamin A

Benign Recurrent Sixth Nerve Palsy Associated with Low Serum Levels of Vitamin A: Case Report

Abstract

Benign recurrent sixth (abducens) nerve palsies in childhood are associated with increased intracranial pressure, neoplasms, trauma or previous viral and bacterial infection diseases. Recurrent sixth nerve palsy is an uncommon clinical picture. The etiology is currently not well described. We report a case who had recurrent sixth nerve palsy based on low serum vitamin A levels. A 13-year-old healthy boy complained about severe headache and inability to look to the left side due to 6th nerve palsy on his left eye and mentioned that the symptoms were repeated every 8 months. He was admitted to the Pediatric Neurology Clinic, with the diagnosis of recurrent 6th nerve palsy. He was treated with vitamin A supplements due to low vitamin A serum levels. The symptoms resolved significantly after the medical treatment was initiated. His parents did not allow us to perform lumbar puncture. However, symptoms such as headache and vomiting especially in the mornings due to high intracranial pressure and sixth nerve palsy without papilledema indicated idiopathic intracranial hypertension. Previous studies have reported pseudotumor cerebri related to hypovitaminosis A. We present a pediatric case with pseudotumor cerebri and hypovitaminosis A, which should be considered in the differential diagnosis in patients with recurrent 6th nerve palsy

Keywords

• Benign recurrent abducens palsy, Idiopathic intracranial hypertension, Pseudotumor cerebri, Vitamin A

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