Two cases of fourth nerve palsy in pregnancy

Abstract

Aim: To present two cases of recent-onset fourth nerve palsies during pregnancy. Methods: Two pregnant patients presented to A&E with recent-onset diplopia due to isolated right superior oblique palsy. Patient 1, aged 42, complained of a 5-day history of intermittent vertical diplopia at 38 weeks gestation. Patient 2, aged 34, presented with constant horizontal and vertical diplopia at 34 weeks gestation. Results: Two months after giving birth, patient 1 attended the eye clinic reporting her symptoms had completely resolved within 5 days from onset. Patient 2 reported her symptoms resolved within 3 months. Both patients fully recovered, therefore no further management or investigation was required. They both gave birth at term without complication. Patient 1 presented with a slight hyperphoria in primary position, demonstrating binocular single vision (BSV). Ocular motility and Hess chart showed a very slight right superior oblique under-action. Her blood pressure, fundus and media were normal and no underlying pathology was found. No further investigations were undertaken. Patient 2 presented with a slight exotropia and right hypertropia in primary position, with diplopia and no BSV demonstrable. Further orthoptic testing showed right superior oblique under-action. No pathology was found. Conclusions: Cranial nerve palsies developing in pregnancy are rare but have been reported. No pathology was found in our cases; however, the literature does suggest that serious cases could be apparent and should therefore be considered.

Keywords

• Cranial nerves
• Pregnancy