15 year old girl presents with occipital headache 3 days duration, squinting of the left eye 3 days. 6/12 Not improving further BE. LE esotropia 15°. Fundus shows Papilloedema BE. CT Scan normal (? ). )

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Ct normal papilloedema must examine for 1 malignant hypertesion ( rule out kiney function test or phaochromocytoma) 2 must also consider psuedotumor ceribri

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Check blood pressure, diabetes,....take history of any drug abuse ... If CT normal, treat according to pseudotumour cerebri... Lumber puntchure pressure and cytology to be assessed by nourologist. Otherwise MR venography is investigation of choice

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Both eyes papilloedema ( grade 4 hypertensive retinopathy. ) To look for malignant hypertension , & benign intracranial hypertension.

Advised MRI brain and orbit (plain and contrast) to rule out space occupying lesion. Soft tissue mass in orbit, sinus thrombosis intracranially, space occupying malignancy etc needs to be ruled out. Looks like left Lat rectus muscle palsy with bilateral papilloedema. Neurological opinion required. All the systemic investigations should be done to rule out Tb, Neurocysticercosis, DM, connective tissue disorder, vascular occlusion etc

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1)Get an expert opinion regarding CT 2)Check colour vision 3)Check blood pressure to rule out malignant hypertension 4)Get fields done - if it is just a blind spot enlargement treat as BIH if any altitudinal defects of central scotomas treat as neurotetinitis

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Do MRI brain+orbit(1 mm optic cuts) Write a letter to radiologist to rule out optic neuritis including retrobulbar neuritis. If MRI comes normal then labelled the diagnosis as pseudotumour cerebri and treat accordingly.

In this case please rule out Systemic Hypertension and Diabetes, then treat this case as Intracranial hypertension, as 6 th N. palsies are common due to path of 6 th nerve over petro shenoidal ridge. High dose of steroids IV can revert the syptoms... Papilledema takes few weeks to disappear.

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Left LATERAL RECTUS PALSY probably due to raised ICT. CT BRAIN should be done to rule out ICSOL

CT scan second opinion  Rule out malignant hypertension  Pseudo tumour treatment In CT Scan see the pathway of sixth nerve in brain  Rule out Ent problems like ear infections leading to mastoiditis

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Papilloedama b/e is because of raised iop leads to l t lateral rictus palsy   Because  abducent nerve supplies the 6 the nerve & it has longest course in the brain & also it crosses over the petrodollars part of temporal bone .But CT scan is normal then in my opinion diagnosis may be pseudo tumour or malignant hypertension. Also one must go for mri.Pt must be given I/ v mannitol & tab diamond to lower down the ice. Thanks.

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