Neurology and Clinical Neuroscience | 2019
Neurofibromatosis two presenting with bilateral sixth and seventh nerve palsies
Abstract
A 25-year-old female was admitted with weakness of facial muscles and binocular horizontal diplopia within 3 h of onset. She was previously healthy and her family history was remarkable for brain tumors. The neurological examination showed weakness of bilateral upper and lower facial muscles associated with bilateral lateral rectus muscle palsy. Laboratory tests were within normal limits. A noncontrast cranial computed tomography (CT) scan was suggestive of tumors in the posterior cranial fossa; a contrast CT scan revealed the lesions (Fig. 1). Prednisone 60 mg/day was started. Upon further questioning, the patient reported that in the maternal side of the family, there were three relatives, including her mother, who had a diagnosis of neurofibromatosis 2 (NF2). On the seventh admission day, she was referred to the neurosurgical service of another city. Neurofibromatosis 2 is characterized by bilateral vestibular schwannomas and schwannomas of other cranial, spinal, and peripheral nerves. The clinical manifestations can result from mass effect or mononeuropathies. Acquired abducens nerve palsy is usually an isolated event, and the presentation of both sixth and seventh cranial nerve palsies is relatively rare. In this way, to the author’s knowledge, a patient with NF2 presenting with bilateral sixth and seventh cranial nerve palsy has not been reported until the present moment.