Analysis and comparison of synovitis in rheumatoid arthritis and osteoarthritis patients

Abstract

Idiopathic intracranial hypertension (IIH) is a disorder that leads to isolated raised intracranial pressure characterized by classical symptoms and signs such as headache, papilledema, sixth nerve palsy causing diplopia and pulsatile tinnitus.In our case report, we present a 20-year-old primigravida suffering from IIH presenting with unusual clinically elicited signs, including bilateral proptosis, unilateral ophthalmoplegia, and unilateral facial nerve palsy. Fundoscopy revealed bilateral papilledema and visual field examination showed enlarged blind spots in both eyes. Lumbar puncture was done to detect the opening pressure of cerebrospinal fluid which was measured to be 57cm of water. MRI brain + venogram was suggestive of vertical kinking of right optic nerve and tortuosity of bilateral optic nerves along with stenosis in bilateral transverse sinuses. In previous literature, there are only two reported cases of IIH that were associated with proptosis, both presenting unilaterally, and one reported case of IIH presenting with complete unilateral facial palsy. When a patient presents with these unorthodox signs, the diagnosis of IIH cannot be excluded.