Proximal Limb Weakness Reverting After CSF Diversion In Intracranial Hypertension

Abstract

We report about two young girls who developed progressive visual failure secondary to increased intracranial pressure and had significant proximal muscle weakness of limbs. Patients with elevated intracranial pressure (ICP) may present with "false localizing signs", besides having headache, vomiting and papilledema. Radicular pain as a manifestation of raised ICP is rare and motor weakness attributable to polyradiculopathy is exceptional. Two patients with increased intracranial pressure without lateralizing signs′ had singnificant muscle weakness. Clinical evaluation and laboratory tests did not disclose any other cause for weakness. Following theco-peritoneal shunt, in both patients, there was variable recovery of vision but the proximal weakness and symptoms of elevated ICP improved rapidly. Recognition of this uncommon manifestation of raised ICP may obviate the need for unnecessary investigation and reduce morbidity due to weakness by CSF diversion procedure.