PMC8241201_01
A Patient was unable to wrinkle forehead on the left side. B Unable to close left eye completely. C Smiling:deviation of corner of the mouth. D Limited abduction of the left eye (abducens nerve palsy)
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Fig1
Reduced movement of the forehead had been noted on the left side (absent wrinkle on the left side) (Fig. 1A). Patient was unable to close his left eye completely at rest (Fig. 1B). On smiling, there was deviation of angle of the mouth and decreased activity of the muscles on the left side (Fig. 1C). Restriction in looking at the lateral side was detected on the left side (Fig. 1D).
Brain MRI showed A normal sella turcica appearance, B normal perioptic disc space, and C normal size of ventricles
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Fig2
Magnetic resonance imaging (MRI) and brain computed tomography (CT) scan showed no space occupying lesion, normal sella appearance (Fig. 2A), normal perioptic disc spaces (Fig. 2B), no deformity, displacement, or obstruction of the ventricular system (Fig. 2C).
Fundoscopy showed bilateral optic disc swellings (grade 2 papilledema)
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Fig3
On follow-up 1 month later, there was significant improvement in headache and visual obscurations, and vomiting was stop with partial resolution of papilledema to grade 2 (Fig. 3). 