Author: Selma Chiguer
Co-authors: Iatissam Elbelhadji, Adil Mchachi, Leila Benhmidoune, Rayad Rachid, Mohamed Elbelhadji
Abstract
PUROPOSEAcute hypervitaminosis A is mainly caused by dietary intake such as fish liver, and is responsible of intense headaches, nausea, vomiting, myalgias, and erythrosis or even intracranial hypertension, with mucocutaneous desquamation in the days that follow. Thus, the ocular manifestations of this intoxication are little known.
We report the case of an 8-year-old girl, admitted for an acute paralysis of the abducens nerve in a context of food intoxications.
SETTING
Adult Ophthalmology Department, 20 August 1953 Hospital / Ibn Rochd University Hospital, Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
METHODS
We report the case of an 8-year-old girl without pathological antecedents, who consulted a pediatrician 3 days before for a food intoxications following the consumption of tuna liver, put under medical treatment, complicated by an acute paralysis of the abducens nerve with binocular diplopy.
RESULTS
The systemic examination revealed general asthenia, abdominal pain with vomiting, and diffuse skin desquamation. The ophthalmological examination revealed a convergent strabismus on the right side with horizontal binocular diplopia, in both eyes, visual acuity was 10/10 with a normal pupillary reflex and intraocular pressure, an examination of the anterior segment was normal, with a bilateral grade 1 papillary oedema in fundus examination.
The cerebral MRI in search of hydrocephalus came back normal, we completed by a lumbar puncture which found a normal pressure lower than 25 mmHg. The clinical presentation was suggestive of acute food intoxication, so we ordered a toxicological evaluation which revealed an extremely high level of vitamin A.
We kept the child under surveillance with symptomatic treatment with a good evolution.
Concerning the management of the paralysis of the 6th nerve, we started a treatment with alternate occlusion 1 day out of 2. The evolution was marked 6 months later by an improvement of the diplopia and the strabismus.
CONCLUSION
The paralysis of the abducens nerve has never been described in the literature as a complication of an acute intoxication by hypervitaminosis A, we can connect it to a paralysis of the abducens nerve secondary to intracranial hypertension which is a symptom found in hypervitaminosis A by decrease of the absoprtion of the cephalo-rachidian fluid, but in our patient we did not find a symdrome of HTIC. Thus, the paralysis of the oculomotor nerves can be considered a symptom of hypervitaminosis A intoxications by alterations of the nerve fibers? Or the paralysis of the abducens nerve is due to a minimal intracranial hypertension that went unnoticed in our patient?
