Páralisis del sexto par craneal, una rara e inusual presentación de preeclampsia

Abstract

We report the case of a 34-year-old female patient, without relevant medical records, with a single pregnancy of 36 + 5 weeks, who suddenly presented diplopia and pain in the right eye of 4 days’ evolution. During the evaluation in the Emergency Department, hypertension 144/93 mmHg was evidenced. No other neurological symptoms were found. The neurologist confirms a right abducens nerve palsy, with the rest of the neurological examination being normal. She was admitted to the Critical Patient Unit for imaging studies and hemodynamic monitoring. Magnetic Resonance Imaging (MRI) of the brain was normal. Laboratory tests showed proteinuria in preeclampsia range, so it was decided to interrupt the pregnancy at 37 weeks by cesarean delivery due to lack of obstetrical conditions. During surgery, spinal anesthesia was provided with standard technique, a cerebrospinal fluid (CSF) sample was taken for cytochemical and microbiological studies, which were subsequently reported as normal. No significant hemodynamic alterations were presented during surgery, concluding without incidents. After 48 hours of delivery the NC VI palsy resolves completely. Similar cases have been reported by other authors, highlighting isolated cranial nerve palsy as a unique presentation, without other neurological involvement, a very rare presentation of preeclampsia. The most likely etiology is the compromise of the vessels of the affected nerve, and it is essential to study with a MRI and rule out autoimmune, endocrinologic, neurologic and any infectious disease of the CNS. The approach must be multidisciplinary to decide the risk/benefit of continuing pregnancy. Resolution is spontaneous and during puerperium. It is recommended to manage in the Critical Patient Unit with both neurological and ophthalmologic follow-up during the pre and post delivery period.