Two Cases of Oculomotor Nerve Palsy in Idiopathic Intracranial Hypertension and a Literature Review

Idiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure in the absence of a secondary cause. Classically, it presents with headache, visual obscurations, pulsatile tinnitus, and diplopia, most commonly due to abducens nerve palsy. Involvement of other cranial nerves is rare. We report two patients with oculomotor nerve palsy in the setting of IIH. The first, a 26‐year‐old woman with a body mass index (BMI) of 35 kg/m 2 , had a unilateral complete oculomotor nerve palsy, with imaging supportive of IIH and lumbar puncture opening pressure > 55 cmH 2 O. The second, a 19‐year‐old man with a BMI of 38.5 kg/m 2 , had a unilateral partial oculomotor nerve palsy, bilateral abduction paresis, and left‐sided tongue dysgeusia, with imaging supportive of IIH and opening pressure of 36 cmH 2 O. Both demonstrated marked symptomatic improvement on acetazolamide. Including the patients initially presented here, a literature review identified 21 documented cases of oculomotor nerve palsy associated with apparent IIH. Of these, 13 satisfied contemporary or historic diagnostic criteria for IIH. These cases underscore the rarity of this manifestation and the importance of recognizing IIH as a potential cause of oculomotor nerve palsy to ensure timely diagnosis and management and to prevent irreversible vision loss.