What is the only neurological finding that can be found in a patient diagnosed with Idiopathic Intracranial Hypertension?

• A. CN III palsy
• B. CN IV palsy
• C. CN VI palsy
• D. Skew deviation

Answer: (C)

In Idiopathic Intracranial Hypertension, the neurological finding you’re most likely to encounter is a sixth nerve palsy. The abducens nerve has a long, relatively exposed intracranial course, so raised intracranial pressure tends to stretch or compress it, especially as it travels over the petrous apex. This leads to weakness of the lateral rectus muscle and horizontal diplopia that worsens with gaze to the affected side. Other cranial nerves are not typically involved in IIH, so third and fourth nerve palsies, or a skew deviation, are not characteristic features. The hallmark that accompanies the neuro finding is papilledema from the elevated pressure, but the extraocular motor deficit, when present, is most often a sixth nerve palsy.